Appl Clin Inform 2021; 12(02): 222-228
DOI: 10.1055/s-0041-1725184
Research Article

Sexual Orientation Demographic Data in a Clinical Cohort of Transgender Patients

Samuel Dubin
1   NYU Langone Health, New York University School of Medicine, New York, New York, United States
,
Tiffany E. Cook
1   NYU Langone Health, New York University School of Medicine, New York, New York, United States
,
Asa Radix
2   Callen Lorde Community Health Center, NYU Grossman School of Medicine, New York City, New York, United States
,
Richard E. Greene
1   NYU Langone Health, New York University School of Medicine, New York, New York, United States
› Author Affiliations
Funding None.

Abstract

Background There are specific issues regarding sexual orientation (SO) collection and analysis among transgender and nonbinary patients. A limitation to meaningful SO and gender identity (GI) data collection is their consideration as a fixed trait or demographic data point.

Methods A de-identified patient database from a single electronic health record (EHR) that allows for searching any discrete data point in the EHR was used to query demographic data (sex assigned at birth and current GI) for transgender individuals from January 2011 to March 2020 at a large urban tertiary care academic health center.

Results A cohort of transgender individuals were identified by using EHR data from a two-step demographic question. Almost half of male identified (46.70%, n = 85) and female identified (47.51%, n = 86) individuals had “heterosexual/straight” input for SO. Overall, male and female identified (i.e., binary) GI aggregate categories had similar SO responses. Assigned male at birth (AMAB) nonbinary individuals (n = 6) had “homosexual/gay” SO data input. Assigned female at birth (AFAB) nonbinary individuals (n = 56) had almost half “something else” SO data input (41.67%, n = 15). Individuals with “choose not to disclose” for GI (n = 249) almost all had “choose not to disclose” SO data (96.27%, n = 232).

Conclusion Current SO categories do not fully capture transgender individuals' identities and experiences, and limit the clinical and epidemiological utility of collecting this data in the current form. Anatomical assumptions based on SO should be seen as a potential shortcoming in over-reliance on SO as an indicator of screening needs and risk factors.

Protection of Human and Animal Subjects

No human subjects were involved in the project.




Publication History

Received: 24 August 2020

Accepted: 19 January 2021

Article published online:
17 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 National Academy of Medicine. The Health of Lesbian, Gay, Bisexual, and Transgender (LGBT) People: Building A Foundation for Better Understanding. Washington (D.C.): National Academies Press; 2011
  • 2 Cahill S, Singal R, Grasso C. et al. Do ask, do tell: high levels of acceptability by patients of routine collection of sexual orientation and gender identity data in four diverse American community health centers. PLoS One 2014; 9 (09) e107104
  • 3 Office of Disease Prevention and Health Promotion. Lesbian, Gay, Bisexual, and Transgender Health |Healthy People. 2020 . Accessed December 15, 2019 at: https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health
  • 4 Pérez-Stable EJ. Sexual and gender minorities formally designated as a health disparity population for research purposes. Accessed December 15, 2019 at: https://www.nimhd.nih.gov/about/directors-corner/messages/message_10-06-16.html
  • 5 Deutsch MB, Buchholz D. Electronic health records and transgender patients--practical recommendations for the collection of gender identity data. J Gen Intern Med 2015; 30 (06) 843-847
  • 6 Scheffey KL, Ogden SN, Dichter ME. “The idea of categorizing makes me feel uncomfortable”: university student perspectives on sexual orientation and gender identity labeling in the healthcare setting. Arch Sex Behav 2019; 48 (05) 1555-1562
  • 7 Dichter ME, Ogden SN, Scheffey KL. Provider perspectives on the application of patient sexual orientation and gender identity in clinical care: a qualitative study. J Gen Intern Med 2018; 33 (08) 1359-1365
  • 8 Reisner SL, Deutsch MB, Bhasin S. et al. Advancing methods for US transgender health research. Curr Opin Endocrinol Diabetes Obes 2016; 23 (02) 198-207
  • 9 Bosse JD, Chiodo L. It is complicated: gender and sexual orientation identity in LGBTQ youth. J Clin Nurs 2016; 25 (23-24): 3665-3675
  • 10 Ybarra ML, Price-Feeney M, Mitchell KJ. A cross-sectional study examining the (in)congruency of sexual identity, sexual behavior, and romantic attraction among adolescents in the US. J Pediatr 2019; 214: 201-208
  • 11 Dichter ME, Ogden SN. The challenges presented around collection of patient sexual orientation and gender identity information for reduction of health disparities. Med Care 2019; 57 (12) 945-948
  • 12 Tan-McGrory A, Bennett-AbuAyyash C, Gee S. et al. A patient and family data domain collection framework for identifying disparities in pediatrics: results from the pediatric health equity collaborative. BMC Pediatr 2018; 18 (01) 18
  • 13 Berona J, Stepp SD, Hipwell AE, Keenan KE. Trajectories of sexual orientation from adolescence to young adulthood: results from a community-based urban sample of girls. J Adolesc Health 2018; 63 (01) 57-61
  • 14 Katz-Wise SL, Reisner SL, Hughto JW, Keo-Meier CL. Differences in sexual orientation diversity and sexual fluidity in attractions among gender minority adults in Massachusetts. J Sex Res 2016; 53 (01) 74-84
  • 15 Kuper LE, Nussbaum R, Mustanski B. Exploring the diversity of gender and sexual orientation identities in an online sample of transgender individuals. J Sex Res 2012; 49 (2-3): 244-254
  • 16 Meier SC, Pardo ST, Labuski C, Babcock J. Measures of clinical health among female-to-male transgender persons as a function of sexual orientation. Arch Sex Behav 2013; 42 (03) 463-474
  • 17 Coleman E. Assessment of sexual orientation. J Homosex 1987; 14 (1-2): 9-24
  • 18 Deutsch MB, Green J, Keatley J, Mayer G, Hastings J, Hall AM. World Professional Association for Transgender Health EMR Working Group. Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group. J Am Med Inform Assoc 2013; 20 (04) 700-703
  • 19 Deutsch MB, Keatley J, Sevelius J, Shade SB. Collection of gender identity data using electronic medical records: survey of current end-user practices. J Assoc Nurses AIDS Care 2014; 25 (06) 657-663
  • 20 Collin L, Reisner SL, Tangpricha V, Goodman M. Prevalence of transgender depends on the “case” definition: a systematic review. J Sex Med 2016; 13 (04) 613-626
  • 21 Murphy SN, Mendis ME, Berkowitz DA, Kohane I, Chueh HC. Integration of clinical and genetic data in the i2b2 architecture. AMIA Annu Symp Proc 2006; 2006: 1040