Scientific statement calls for more diversity in pediatric endocrine, gender care research
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Key takeaways:
- Endocrine Society’s new statement calls for collection of more data on ethnic groups as well as sexual orientation.
- The authors said a more diverse endocrine workforce is needed to reduce disparities.
Health care professionals must collect more detailed and accurate demographic data and identify factors contributing to health disparities in pediatric endocrinology and gender care, according to a scientific statement.
The Endocrine Society published a new scientific statement on health care disparities in pediatric and LGBTQ populations. The statement expands on the organization’s first scientific statement on health disparities that was released in 2012 and identifies research needs and interventions that should be implemented to reduce endocrine disparities in the future.
“Pediatric endocrine care becomes adult endocrine care through a person’s life course and many underpinnings of adult disease and health disparities start in youth,” Alicia M. Diaz-Thomas, MD, MPH, associate dean of faculty affairs and pediatric endocrinology fellowship program director at the University of Tennessee Health Science Center, told Healio. “Therefore, identifying and addressing pediatric endocrine health disparities will improve adult health disparities. In order to address health disparities, one must understand the upstream determinants that caused them in the first place. Using a framework that incorporates both upstream and downstream determinants illustrates the complexity of the problems and the multipronged approach necessary to address them.”
Diaz-Thomas and colleagues conducted a comprehensive literature search of PubMed to identify studies, systematic reviews and meta-analyses focused on endocrine disparities in youth as well as adult LGBTQ populations. Research was collected for a range of endocrine conditions, including type 1 and type 2 diabetes, prediabetes, obesity, metabolic bone disease, growth disorders and puberty.
Disparities in growth disorders, obesity and diabetes
The authors found several disparities with treatment for puberty and growth. Non-Hispanic white boys with short stature tend to be overtreated with growth hormone, whereas girls and boys from other historically underrepresented groups were not treated as aggressively.
The authors advised using caution with pubertal development metrics, such as Tanner staging, because they likely do not reflect variation between ethnic groups, as they were developed from a European population. Additionally, they said most puberty research focuses on girls and not boys. They recommended longitudinal studies that enroll children at younger ages and have ethnically diverse cohorts to collect more detailed data.
“I would love to see a longitudinal study on puberty and peak bone mass that is global, diverse and includes many of the biological and nonbiological determinants of health,” Diaz-Thomas said. “One of the main barriers we have is funding. Pediatric studies are not well funded. There is also a perception that pediatric research (in terms of clinical trials) is more challenging and risky. The biggest risk we run is not engaging in pediatric research.”
The authors said children from historically underrepresented groups continue to be disproportionally affected by obesity, which contributes to higher rates of type 2 diabetes compared with non-Hispanic white children. More access to optimal diabetes care and technology is crucial for children in all backgrounds to close some of these disparities.
Diaz-Thomas said there are several actions health care stakeholders can take to improve access to obesity and diabetes care. These actions include implementing clinical standards of care that do not account for race, ethnicity or insurance as variables for care, advocating for culturally responsive care in obesity and diabetes and engaging the larger community to improve environmental factors such as access to healthy food and safe places for exercise.
According to the researchers, girls have a higher prevalence of obesity and type 2 diabetes than boys due to lower levels of physical activity and difference in diet choices. They said interventions directed specifically for girls are needed.
Advocacy needed to improve access to gender care
Research for LGBTQ youths and adults has growth rapidly in recent years, according to the authors. However, they said more prospective studies are still needed to determine the timing and duration of gonadotropin-releasing hormone agonist therapy for transgender youths to optimize peak bone mass and determine the prevalence of osteopenia, osteoporosis and fractures in youths and adults.
Two barriers identified for LGBTQ groups are health care system design and health care and education policies. The authors advocated for routine collection of sexual orientation and gender identity in practice.
Additionally, the authors said policies and laws have resulted in shrinking access to care for LGBTQ populations.
“[One of the largest barriers is] recent legislation that attempts erasure of LGBTQIA persons by preventing them from receiving the basic human right of medical care to which they are entitled, curtailing participation in youth sports or discussion of LGBTQIA persons in schools and stigmatizing at-risk LGBTQIA youth,” Diaz-Thomas said.
Diaz-Thomas said other barriers to care for the LGBTQ population include lack of insurance coverage for reproductive, surgical or hormonal care; lack of providers trained in delivery of gender-affirming care and heteronormative medical care and medical education systems.
“Advocacy is key,” Diaz-Thomas said. “We need to use our voices and work through our professional societies, our political systems and our own communities to advocate for our patients. Additionally, we need to help those persons caught without access to health care in their own community and find resources that they can access to receive the care they need.”
More diverse studies, workforce needed
Overall, the research group found many studies did not adhere to recommendations in the Endocrine Society’s 2012 scientific statement of identifying racial and ethnic subgroups. Most studies analyzed by the authors grouped Black, Hispanic and Asian populations together. The researchers said a big area of future research should focus on determining which ethnic subgroups require focused interventions and resources to achieve health equity.
The authors also touched on a lack of diversity among the biomedical workforce. The release of the Flexner Report in 1910 led to a lack of historically Black medical schools during the 20th century and resulted in a less diverse workforce.
“A lack of diversity in our medical workforce only serves to perpetuate disparities experienced in our communities with regard to health,” Diaz-Thomas said.
The authors said the health care community should follow recommendations from the Endocrine Society’s Policy Perspective on eradicating racism to diversify the endocrine workforce. They said diversity efforts should include bilingual people as well as workers from the LGBTQ community.
For more information:
Alicia Diaz-Thomas, MD, MPH, can be reached at adiaztho@uthsc.edu.
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