The majority of LGBTQ adults report experiencing discrimination from a health care professional. Compared to cisgender heterosexual adults, LGBTQ populations experience multi-level, psychological and social stressors, including exposure to discrimination and violence, yet data on how these stressors affect their cardiovascular health is limited. Policy changes within health care education and clinical settings are needed to improve LGBTQ cardiovascular health, experts urge.
In terms of health, LGBTQ orientation is considered a «sexual minority,» and transgender or gender non-conforming is considered a «gender minority.»
The statement examines existing research about LGBTQ-specific links to cardiovascular health disparities, identifies gaps in the body of knowledge and provides suggestions for improving cardiovascular research and care of LGBTQ people.
«This is particularly important now, at a time when there is increased awareness of health inequities related to unequal treatment and discrimination in the U.S.,» says Billy A. Caceres, Ph.D., R.N., FAHA, chair of the writing group for the statement and an assistant professor at the Columbia University School of Nursing in New York City. «LGBTQ individuals are delaying primary care and preventative visits because there is a great fear of being treated differently. Being treated differently often means receiving inadequate or inferior care because of sexual orientation or gender identity.»
LGBTQ populations face unique stressors, such as family rejection and anxiety over concealment of their sexual orientation or gender identity. Multi-level minority stressors and general stressors often interact in complicated ways to impair LGBTQ health. In addition, LBGTQ adults in historically underrepresented racial or ethnic groups experience higher poverty levels, insecure housing and fewer health care options compared to their white LGBTQ peers.
The writing group noted trust toward health care professionals is still lacking among many members of the LGBTQ community, and health care professionals need more education on how to provide appropriate care for LGBTQ patients. Caceres says, «It is paramount to include content about LGBTQ health in clinical training and licensure requirements in order to address these cardiovascular health disparities.»
Accrediting bodies and organizations responsible for health care professional curricula have not specifically required LGBTQ-related content, thus very little exists in health professional education training. A 2018 online survey of students at 10 medical schools found approximately 80% of students did not feel competent to provide care for transgender patients. Another study of more than 800 physician residents across 120 internal medicine residencies in the U.S. found no difference in knowledge between the baseline and post-graduate years when it came to LGBTQ-specific health topics. The statement notes that the Accreditation Review Commission on Education for the Physician Assistant began requiring LGBTQ curricular content in September 2020.
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Materials provided by American Heart Association. Note: Content may be edited for style and length.