Introduction
Sexual orientation and gender identity data collection is necessary to address health
inequities. This study examines sexual orientation and gender identity data reporting
among community health centers.
Methods
Using the 2016–2019 Uniform Data System for 1,381 community health centers, trends
in reporting of sexual orientation and gender identity data were examined. Multivariable
logistic regression was used to assess associations between community health center
characteristics and whether sexual orientation and gender identity data were available
for ≥75% of a community health center's patients in 2019. Data were analyzed in 2021.
Results
In 2016-2019, the percentage of community health centers with sexual orientation and
gender identity data for ≥75% of patients increased from 14.9% to 53.0%. In 2019,
community health centers were more likely to have this data for ≥75% of patients if
they were in nonmetro counties (OR=1.48, 95% CI=1.04, 2.10 versus metro), were in
the South (OR=2.27, 95% CI=1.57, 3.31) or West (OR=1.91, 95% CI=1.27, 2.88 versus
the Northeast), and had more patients aged between 18 and 39 years (OR=1.04, 95% CI=1.02,
1.07), between 40 and 64 years (OR=1.04, 95% CI=1.02, 1.06 vs <18 years), or veterans
(OR=1.10, 95% CI=1.01, 1.20). This was less likely among community health centers
serving 10,000–20,000 patients (OR=0.70, 95% CI=0.52, 0.95) and >20,000 patients (OR=0.44,
95% CI=0.32, 0.61 vs <10,000) and community health centers with more patients of American
Indian/Alaskan Native (OR=0.98, 95% CI=0.97, 0.99) or unknown race (OR=0.92, 95% CI=0.86,
0.97 versus White).
Conclusions
Collection of sexual orientation and gender identity data by community health centers
has increased substantially since 2016, although gaps remain.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Sexual orientation and gender identity data collection: clinical and public health importance.Am J Public Health. 2020; 110: 991-993https://doi.org/10.2105/AJPH.2020.305722
- Planning and implementing sexual orientation and gender identity data collection in electronic health records.J Am Med Inform Assoc. 2019; 26: 66-70https://doi.org/10.1093/jamia/ocy137
- Optimizing gender-affirming medical care through anatomical inventories, clinical decision support, and population health management in electronic health record systems.J Am Med Inform Assoc. 2021; 28: 2531-2535https://doi.org/10.1093/jamia/ocab080
- The “Ask” Is the “Answer”: implementing routine documentation of sexual orientation and gender identity in health care.Am J Public Health. 2019; 109 ([published correction appears in Am J Public Health. 2019;109(10):e4]): 1071-1073https://doi.org/10.2105/AJPH.2019.305192
- Sexual and gender minority health in the COVID-19 pandemic: why data collection and combatting discrimination matter now more than ever.Am J Public Health. 2020; 110: 1360-1361https://doi.org/10.2105/AJPH.2020.305829
- The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.The National Academies Press, Washington, DC2011
The Joint Commission. Advancing effective communication, cultural competence, and patient- and family-centered care for the lesbian, gay, bisexual, and transgender (LGBT) community: a field guide. Oak Brook, IL: The Joint Commission.https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/health-equity/lgbtfieldguide_web_linked_verpdf.pdf?db=web&hash=FD725DC02CFE6E4F21A35EBD839BBE97&hash=FD725DC02CFE6E4F21A35EBD839BBE97. Published 2011. Accessed January 18, 2022.
- Considerations for transgender population health research based on US national surveys.Ann Epidemiol. 2022; 65: 65-71https://doi.org/10.1016/j.annepidem.2021.10.009
- Implementation of gender identity and assigned sex at birth data collection in electronic health records: where are we now?.Int J Environ Res Public Health. 2021; 18: 6599https://doi.org/10.3390/ijerph18126599
- Risks, benefits, and importance of collecting sexual orientation and gender identity data in healthcare settings: a multi-method analysis of patient and provider perspectives.LGBT Health. 2017; 4: 141-152https://doi.org/10.1089/lgbt.2016.0107
- Using sexual orientation and gender identity data in electronic health records to assess for disparities in preventive health screening services.Int J Med Inform. 2020; 142104245https://doi.org/10.1016/j.ijmedinf.2020.104245
- Proportion of patients who disclose their sexual orientation to healthcare providers and its relationship to patient outcomes: a meta-analysis and review.Patient Educ Couns. 2018; 101: 1549-1560https://doi.org/10.1016/j.pec.2018.05.001
- Structural transphobia, homophobia, and biphobia in public health practice: the example of COVID-19 surveillance.Am J Public Health. 2021; 111: 1620-1626https://doi.org/10.2105/AJPH.2021.306277
- Sexual orientation-related disparities in health conditions that elevate COVID-19 severity.Ann Epidemiol. 2021; 66: 5-12https://doi.org/10.1016/j.annepidem.2021.11.006
- Evidence of social and structural COVID-19 disparities by sexual orientation, gender identity, and race/ethnicity in an urban environment.J Urban Health. 2021; 98: 27-40https://doi.org/10.1007/s11524-020-00497-9
- Electronic health records as an equity tool for LGBTQIA+ people.Nat Med. 2021; 27: 2071-2073https://doi.org/10.1038/s41591-021-01592-3
- Program assistance letter (PAL 2016-02). Approved uniform data system changes for calendar year 2016.Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, MD2016 (https://bphc.hrsa.gov/sites/default/files/bphc/datareporting/reporting/program-assistance-letter-2016-02.pdf. Accessed November 17, 2020)
Uniform data system reporting instructions for 2016 Health Center Data. Health Resources & Services Administration, Bureau of Primary Health Care.https://bphc.hrsa.gov/datareporting/reporting/index.html. Updated November 4, 2016. Accessed February 14, 2022.
- Inclusion of sexual orientation and gender identity in Stage 3 Meaningful Use Guidelines: a huge step forward for LGBT health.LGBT Health. 2016; 3: 100-102https://doi.org/10.1089/lgbt.2015.0136
- Collecting Sexual Orientation and Gender Identity Data in Electronic Health Records: Workshop Summary.National Academies Press (U.S.), Washington, DC2013
- Improving data for the LGBT community.HHS, Washington, DC2011 (https://www.minorityhealth.hhs.gov/assets/pdf/checked/1/Fact_Sheet_LGBT.pdf. Accessed August 20, 2021)
- National Health Center data.2021 (https://data.hrsa.gov/tools/data-reporting/program-data/national. Accessed July 19, 2021)
- Required sexual orientation and gender identity reporting by US health centers: first-year data.Am J Public Health. 2019; 109: 1111-1118https://doi.org/10.2105/AJPH.2019.305130
Uniform data system reporting instructions for 2017 Health Center Data. Health Resources & Services Administration, Bureau of Primary Health Care.https://bphc.hrsa.gov/datareporting/reporting/index.html. Updated August 31, 2017. Accessed February 14, 2022.
Uniform data system reporting instructions for 2018 Health Center Data. Health Resources & Services Administration, Bureau of Primary Health Care.https://bphc.hrsa.gov/datareporting/reporting/index.html. Updated June 1, 2018. Accessed February 14, 2022.
Uniform data system reporting instructions for 2019 Health Center Data. Health Resources & Services Administration, Bureau of Primary Health Care. https://bphc.hrsa.gov/datareporting/reporting/index.html. Updated May 28, 2019. Accessed February 14, 2022.
Rural-urban continuum codes. U.S. Department of Agriculture Economic Research Services.https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/. Updated December 10, 2020. Accessed July 16, 2021.
RStudio: integrated development for R. RStudio Team, RStudio, PBC. http://www.rstudio.com/. Accessed January 10, 2022.
- 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; 9e107104https://doi.org/10.1371/journal.pone.0107104
- Training in sexual and gender minority health - expanding education to reach all clinicians.N Engl J Med. 2018; 379: 2388-2391https://doi.org/10.1056/NEJMp1810522
- The role of implementation science in reducing sexual and gender minority mental health disparities.LGBT Health. 2021; 8: 169-172https://doi.org/10.1089/lgbt.2020.0379
- Sexual orientation and gender identity data collection at US Health Centers: impact of city-level structural stigma in 2018.Am J Public Health. 2021; 111: 2059-2063https://doi.org/10.2105/AJPH.2021.306414
- Barriers to health care among adults with minoritized identities in the United States, 2013–2017.Am J Public Health. 2020; 110: 857-862https://doi.org/10.2105/AJPH.2020.305598
- Underserved populations with missing race ethnicity data differ significantly from those with structured race/ethnicity documentation.J Am Med Inform Assoc. 2019; 26: 722-729https://doi.org/10.1093/jamia/ocz040
- Intersectionality and health inequities for gender minority Blacks in the U.S.Am J Prev Med. 2020; 59: 639-647https://doi.org/10.1016/j.amepre.2020.04.013
- The association of multiple identities with self-directed violence and depression among transgender individuals.Suicide Life Threat Behav. 2016; 46: 535-544https://doi.org/10.1111/sltb.12234
Wilson BDM, Bouton L, Mallory C. American Indian and Alaska Native LGBT adults in the US: LGBT well-being at the intersection of race. Los Angeles, CA: Williams Institute, UCLA School of Law. https://williamsinstitute.law.ucla.edu/publications/aian-lgbt-adults-us/. Published October 2021. Accessed January 10, 2022.
- Will veterans answer sexual orientation and gender identity questions?.Med Care. 2017; 55: S85-S89https://doi.org/10.1097/MLR.0000000000000744
- Uniform data system reporting instructions for 2020 Health Center Data.Health Resources & Services Administration, Bureau of Primary Health Care, Rockville, MD2020 (https://bphc.hrsa.gov/sites/default/files/bphc/datareporting/pdf/2020-uds-manual.pdf. Published August 21, 2020. Accessed February 14, 2022)
Article Info
Publication History
Published online: February 26, 2022
Identification
Copyright
© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
