Addressing Health Disparities in LGBTQ+ Nephrology Care

Individuals within the LGBTQ+ community often face discrimination and experience health disparities, significantly impacting their nephrology care. This was highlighted by Yuvaram Reddy, MBBS, MPh, FASN, Assistant Professor and Director of Diversity, Equity, and Inclusion for the Renal-Electrolyte & Hypertension Division at the University of Pennsylvania, during a session at the American Society of Nephrology (ASN) 2023 Kidney Week Annual Meeting in Philadelphia.

Behaviors sometimes labeled as “risky,” such as tobacco use, can be influenced by systemic issues, leading to negative health outcomes. As Reddy pointed out, “The system isn’t really designed for everyone.”

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Reddy identified six key factors contributing to health disparities within the LGBTQ+ community: social determinants of health, inequalities, limited access to inclusive care, safety concerns, fragmented care (silos), and pervasive stigma. These factors can create barriers to comfortable and effective care.

It’s important to recognize that these disparities aren’t unique to the LGBTQ+ community. As Reddy noted, similar challenges exist for many underrepresented and marginalized groups.

The Impact of Discrimination and Stigma

Discrimination can lead to depression, a significant health concern exacerbated by stigma. LGBTQ+ youth are particularly vulnerable. A 2022 Trevor Project survey revealed that 45% of LGBTQ+ youth seriously considered suicide. Among adults, transgender individuals are four times more likely to attempt suicide than cisgender heterosexual adults.

Medical professional talking to a patient, highlighting the importance of inclusive healthcare.

Transgender adults often distrust the healthcare system. While economic security is crucial for healthcare access, one in three transgender adults have experienced homelessness. Two-thirds express concern about their sexual orientation or gender identity (SOGI) influencing their healthcare evaluations, a concern directly relevant to nephrology.

Challenges in Nephrology Care

Reddy observed a lack of awareness campaigns regarding dialysis for LGBTQ+ individuals, leading to insecurity about seeking care and reduced self-reporting of SOGI at transplant clinics and dialysis facilities. Many LGBTQ+ patients receiving dialysis report living alone, highlighting the impact of limited social support on health outcomes.

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Fear of judgment from clinicians and the healthcare system can discourage LGBTQ+ individuals from considering living donor donation. This creates a negative cycle where kidney disease exacerbates mental health issues, contributing to behaviors like smoking and obesity. Simultaneously, stigma and discrimination increase stress, worsening health and disease progression.

Addressing Risk Factors and Systemic Issues

Obesity and tobacco use are risk factors for chronic kidney disease (CKD), and gay women have significantly higher rates of both compared to cisgender heterosexual women. This correlates with data on economic and housing insecurity and limited food access.

Other consequences of discrimination include alcohol and drug use, financial instability, lack of social support, and lack of health insurance. The political landscape also plays a role, with many states lacking supportive legislation for LGBTQ+ individuals. Reddy pointed out that approximately 25 states have discriminatory laws affecting 40% of LGBTQ+ Americans.

Promoting Inclusivity in Kidney Care

Reddy offered several strategies to enhance inclusivity in kidney care practices:

• Inclusive patient intake forms with gender and relationship options
• Consistent use of correct pronouns
• Avoiding outdated terminology like “homosexual” and using “partner” unless a specific term is provided
• Open communication about sexual and substance use history
• Providing gender-neutral restrooms
• Staff training on gender identity and sensitivity
• Staying informed about LGBTQ+ healthcare research
• Displaying pride flags to create a welcoming environment

The Path Forward

Numerous factors contribute to health disparities for LGBTQ+ individuals, and further research is needed to fully understand these mechanisms. However, intentional efforts by individuals and organizations can make a significant difference. By implementing inclusive practices and fostering a supportive environment, healthcare providers can improve the quality of nephrology care for the LGBTQ+ community.

Reference

Reddy Y. Health Care Disparities in the LGBTQ+ Population. Session. ASN Kidney Week Annual Meeting. November 2 to 5, 2023. Philadelphia, PA.