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October 09, 2023
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Sexual, gender minorities experience increased risk for asthma severity

Fact checked byKristen Dowd
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Key takeaways:

  • E-cigarette and tobacco cigarette use augmented asthma severity risk.
  • Steroid and inhaler use were not associated with sexual orientation.
  • Research may inform culturally appropriate interventions.

HONOLULU — Patients who identified as sexual and gender minorities experienced greater risks for asthma severity than patients who identified as heterosexual, according to an abstract presented at the CHEST Annual Meeting.

The use of e-cigarettes alone or with tobacco cigarettes augmented these risks, Tugba Kaplan, MD, internal medicine resident at Anne Arundel Medical Center, and colleagues wrote.

Odds ratios among patients who identify as sexual and gender minorities included 1.33 for refraining from daily activity and 1.82 for shortness of breath.
Data were derived from Kaplan T, et al. Asthma severity among sexual and gender-minoritized people: Results from a nationally representative study. Presented at: CHEST Annual Meeting; Oct. 8-11, 2023; Honolulu.

Recent guidelines from the Global Initiative for Asthma (GINA) say that clinicians should consider both symptom control and the likelihood of future exacerbations when evaluating asthma severity, Kaplan told Healio.

Tugba Kaplan

“Even when symptom control is optimal, asthma exacerbation risk factors such as socioeconomic challenges and poor adherence to medications and follow-up visits, which may be linked to health care disparities, can still play a significant role for asthma severity assessment and proper further management,” Kaplan said.

Also, Kaplan noted previous research reporting that people who identify as sexual and gender minorities (SGM) encounter various health disparities and an elevated susceptibility to specific health concerns.

“Therefore, in our study, we aimed to assess the severity of asthma in SGM individuals who are known to face disparities in health care access,” she said.

Study design, results

The cohort included 1,815 adults who identified as SGM and 12,879 who identified as heterosexual from the Population Assessment of Tobacco and Health Study (PATH).

“To the best of my knowledge, this is the first nationally representative study assessing asthma severity among SGM,” Kaplan said.

Researchers used six questions with dichotomized response options to classify asthma as intermittent or persistent per GINA guidelines.

Results showed the SGM group was more likely to refrain from daily activity (OR = 1.33; 95% CI, 1.1-1.61) and have shortness of breath (OR = 1.82; 95% CI, 1.32-2.51) compared with the heterosexual group.

Odds ratios also included 3.89 (95% CI, 1.99-7.63) for urgent care visits among SGM patients with dual use of e-cigarettes and tobacco cigarettes compared with heterosexual patients with dual use.

SGM patients with lifetime exclusive e-cigarette use had an odds ratio of 7.81 (95% CI, 2.93-20.81) for waking up at night compared with heterosexual patients with lifetime exclusive e-cigarette use.

However, among those who never used any tobacco products, odds ratios included 0.74 (95% CI, 0.48-1.14) for urgent care visits and 0.85 (95% CI, 0.64-1.12) for waking up at night for SGM patients compared with heterosexual patients.

The researchers additionally did not find any associations between steroid and rescue inhaler use and sexual orientation.

“We have some other significant findings which might have affected asthma severity among SGM people in our study,” Kaplan said. “We are planning to present them with more details in a peer-reviewed article.”

Conclusions, next steps

Considering this increased risk for asthma severity augmented by e-cigarette and tobacco cigarette use among SGM patients, the researchers called for research in identifying and developing culturally appropriate preventive interventions for lung health risk reductions including asthma severity risks among SGM patients.

“Future studies assessing the effect of the health care disparities on asthma severity among SGM people are significantly needed,” Kaplan said.

Kaplan also said that physicians can use these findings to improve care today.

“In the context of chronic illnesses like asthma, it is crucial to offer patients the knowledge and tools required to proficiently handle their condition,” Kaplan said.

The most efficient way to accomplish this is by fostering a collaborative relationship between patients and their health care providers, she continued.

“When tailoring and assessing self-management strategies for diverse cultural contexts, for the health care providers, it is essential to take sociocultural factors into account,” she said.

Patients who identify as SGM experience health disparities and are at higher risk for certain conditions, Kaplan said, but it appears that they have less access to health care and worse health outcomes that may be related to their reluctance to reveal their sexual orientation to health care providers due to concerns about discrimination.

These outcomes also may be related to the health care system’s limited awareness of SGM health issues that stem from the heteronormative nature of and potential gaps in insurance coverage, Kaplan said.

“It was also revealed that SGM people are more likely to face disparities in several health indicators such as perceived health status, obesity, smoking and health care access,” Kaplan said.

In addition to the risk factors that make patients who identify as SGM less likely to receive preventive health care, Kaplan said, factors such as age, income, education, health insurance and having a regular health care provider or location appear more related to increased asthma severity.

This is because encounters with the health care environment are often negative due to perceived or internalized stigma, causing nonadherence with regular follow-up visits and contributing to delays in health care, Kaplan said.

“Overall, it is imperative to ensure that SGM individuals have the support and ability to engage in their health care and that health care providers should receive training on anti-discrimination policies, both implicit and explicit biases, and recognize the impact of intersectionality in advancing health equity to do their best for preventing the health care disparities,” Kaplan said.

“Previous studies about SGM people showed that the lack of culturally competent providers trained in the health care needs of the SGM community is a part of health care disparities for this population,” she said.

For more information:

Tugba Kaplan, MD, can be reached at tugbakaplanmd@gmail.com.