Scientific statement calls for greater diversity in endocrinopedic and gender care research

Key points:

• The Endocrine Society\’s new statement calls for the collection of more data on ethnic groups and sexual orientation.
• The authors said a more diverse endocrine workforce is needed to reduce disparities.

Healthcare providers need to collect more detailed and accurate demographic data and identify factors contributing to health care disparities in pediatric endocrinology and gender care, according to a scientific statement.

Alicia M. Diaz-Thomas

The Endocrine Society has released a new scientific statement on health disparities in pediatric and LGBTQ populations. The statement expands on the organization\’s first scientific statement on health disparities 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 throughout a person\’s life course, and many of the underpinnings of adult disease and health disparities begin in young people,” Alicia M. Diaz-Thomas, MD, MPH, the associate dean of faculty affairs and director of the pediatric endocrinology fellowship program at the University of Tennessee Health Science Center told Healio. “Therefore, identifying and addressing pediatric endocrine health disparities will improve adult health disparities. To address health disparities, it is necessary to 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 multi-pronged approach needed to address them.

Diaz-Thomas and colleagues conducted a comprehensive PubMed literature search to identify studies, systematic reviews and meta-analyses focusing on endocrine disparities in youth and adult LGBTQ populations. Research has been collated for a range of endocrine conditions, including type 1 and type 2 diabetes, prediabetes, obesity, metabolic bone disease, growth disorders and puberty.

Disparities in stunting, obesity and diabetes

The authors found several disparities in the treatment of puberty and growth. Non-Hispanic white boys with short stature tend to be overtreated with growth hormone, while girls and boys from other historically underrepresented groups have not been treated aggressively.

The authors advised caution with metrics of pubertal development, such as Tanner staging, because they likely do not reflect variation between ethnic groups, as they were developed from a European population. Furthermore, they said that most of the research on puberty focuses on girls and not boys. They recommended longitudinal studies enrolling younger children and having ethnically diverse cohorts to gather more detailed data.

\”I would like to see a longitudinal study of puberty and peak bone mass that is global, diverse, and includes many of the biological and nonbiological determinants of health,\” said Diaz-Thomas. “One of the main hurdles 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 greatest risk we run is not to engage in pediatric research\”.

The authors said that children from historically underrepresented groups continue to be disproportionately affected by obesity, which contributes to higher rates of type 2 diabetes than non-Hispanic white children. Greater access to optimal diabetes care and technology is critical for children of all backgrounds to bridge 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 disregard race, ethnicity or insurance as variables for care, advocating for culturally responsive care in obesity and diabetes, and engaging the wider community to improve environmental factors such as access to healthy food and safe places to 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 dietary choices. They said interventions aimed specifically at girls are needed.

Advocacy needed to improve access to gender-based care

Search for LGBTQ youth and adults has grown rapidly in recent years, according to the authors. However, they said that more prospective studies are still needed to determine the timing and duration of gonadotropin-releasing hormone agonist therapy for transgender youth to optimize peak bone mass and determine the prevalence of osteopenia, osteoporosis, and fractures. in young people and adults.

Two barriers identified for LGBTQ groups are health system design and health and education policies. The authors advocated routine collection of sexual orientation and gender identity in practice.

Furthermore, the authors argued that policies and laws have led to reduced access to care for LGBTQ populations.

“[One of the largest barriers is] recent legislation attempting to erase LGBTQIA people by preventing them from receiving the basic human right of medical care to which they are entitled, limiting participation in youth sports or discussing LGBTQIA people in schools, and stigmatizing at-risk LGBTQIA youth,” Diaz- Thomas said.

Diaz-Thomas said other barriers to caring for the LGBTQ population include a lack of insurance coverage for reproductive, surgical or hormonal treatments; lack of providers trained in the delivery of gender-affirming and heteronormative medical care and medical education systems.

\”Defense is key,\” Diaz-Thomas said. “We must use our voices and work across our professional societies, our political systems and our communities to advocate for our patients. We also need to help those educated people without access to health care in their community and find resources they can access to get the care they need.\”

More diverse studios, workforce needed

Overall, the research team found that many studies do not adhere to the recommendations of the Endocrine Society\’s 2012 scientific statement on identifying racial and ethnic subgroups. Most of the studies reviewed by the authors grouped Black, Hispanic, and Asian populations together. The researchers said a large area of ​​future research should focus on determining which ethnic subgroups require targeted interventions and resources to achieve health equity.

The authors also alluded to the lack of diversity among the biomedical workforce. The publication of the Flexner Report in 1910 led to a shortage of historically black medical schools during the 20th century and resulted in a less diverse workforce.

\”The lack of diversity in our medical workforce only serves to perpetuate the disparities experienced in our communities in regards to health,\” said Diaz-Thomas.

The authors said the healthcare community should follow the recommendations of the Endocrine Society\’s policy perspective on eradicating racism to diversify the endocrine workforce. They said diversity efforts should include bilingual people and workers from the LGBTQ community.

For more information:

Alicia Diaz-Thomas, MD, MPH, can be contacted at adiaztho@uthsc.edu.

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