Handbook of Clinical Gender Medicine. Группа авторов

that when lifespan and disease area variation is accounted for, any noted difference in morbidity rates is attenuated [1]. Others reports suggest that the variation is an artifact due to factors such as higher rates of hospitalization due to childbirth in women, women’s increased tendency toward seeking out health services resulting in higher diagnosis rates as well as higher rates of medication usage, and women’s greater inclination to identify complaints believed to be health related [1].

      Morbidity in Lesbian, Bisexual, Gay, Transgender, and Intersex Populations

      Disparities within LGBT populations as well as differences among them exist in relation to disease patterns and behaviors affecting health. A consistent disparity across LGBT populations is that they are at a higher risk for violence than the general population, with one third to one fourth of this population in the USA having experienced a violent act. Mental health is also an area of special concern, notably depression and anxiety [7, 8]. LGBT people are more than four times as likely to have attempted suicide as the general US population. Eating and body image disorders have a higher prevalence in gay and bisexual men compared to their heterosexual peers [7, 8]. It is believed that all of these mental health conditions are manifested as the result of being marginalized within society, coupled with a history of emotional or physical abuse [7, 8].

      Additionally, higher rates of recreational drug use among gay men, higher rates of obesity among lesbians, and overall higher rates of tobacco use in LGBT populations have been reported in the USA and Canada and may result in increased morbidity [7, 8]. The use of tobacco puts this population at a higher risk for lung cancer and chronic obstructive pulmonary disease, obesity increases the risk of a number of non-communicable diseases, and finally recreational drug use can lead to an increased risk of sexually transmitted diseases due to an increase in high-risk sexual behaviors [7].

      When we look at other areas of increased disease prevalence we see that lesbians are at a greater risk for morbidity and mortality due to gynecological cancers, especially ovarian cancers [7, 8]. This risk is thought to be compounded by the tendency to delay routine healthcare [7, 8]. Higher cancer risk is also seen in men who have sex with men. They have a higher prevalence of anal human papilloma virus which can result in anal cancer [7, 8].

There is little research on transgender morbidity but, due to exposure to hormone therapy over extended periods of time, transgender people may be at increased risk of hormone-related cancers [7, 8]. Special concern also exists regarding the self-administration of high-dose hormone regimens, without medical supervision, within the transgender population [15]. This practice poses an obvious and significant health risk.

      Aging

      Healthy aging is a shared goal between sexes and across the gender continuum, yet as the numbers of aging people grow, our knowledge on the topic does not keep pace and our health systems remain largely focused on curative rather than preventive care.

Interestingly, in some high-income countries the higher rates of morbidity in women compared to men are either somewhat diminished or absent as women age [1]. In contrast, a study within India demonstrated that women over the age of 60 continue to report a higher prevalence of disabilities, worse self-rated health, and marginally lower chronic conditions compared to same-aged men [3]. However, when controlled for a number of socioeconomic conditions, the study shows that financially empowered women have equal or better health than similarly aged men [3]. Another study conducted in Africa and Asia shows conflicting information in that women have significantly worse self-reported health than do men even when differences in demographic and socioeconomic factors are adjusted for [16]. These last findings are of particular interest since the majority of women 60 years of age or older reside in low-and middle-income countries and the overall proportion of older people within these countries is rising [11].

      In light of LGBT populations’ tendency toward having delayed, avoided, or been the recipient of mismanaged care over their lifespan, they are at a greater risk for increased health issues as they age. They are also disadvantaged by the lack of targeted governmental services available and the potential lack of social networks established to help provide them assistance in navigating healthcare systems as they age [7, 8]. Older LGBT people may also have significant concerns about the need for institutional support in residential facilities for the aged due to inherent social prejudices [7].

      Allocation of Resources, Empowerment, and Equity

Any discussion of sex and gender requires acknowledgement of the unequal distribution of assets and power as well the existence of harmful gender norms. The differential distribution of, access to, and control over resources has an effect on health. Health is positively associated with gender equity and lack of equity has a distinctly negative impact on health [1, 17].

      A key predisposing factor for an individual’s health is their level of education, which is also a driver of health literacy. Women in a number of low-and some middle-income countries, particularly in Africa and Asia, are disadvantaged due to having lower literacy rates and significantly lower rates of access to primary and/or secondary schooling in contrast to their male counterparts [11]. Moreover, it has been established that a person’s level of education is positively correlated with their use of healthcare services such as preventive services, intake of fewer prescription medicines, and a lower likelihood of inpatient hospital stays [1]. The social practice of restricting women’s attendance in school has a distinct and long-lasting influence not only on the women’s health but also on the health of their children [11]. There is a growing body of evidence that points to the importance of women’s education for child survival rates.

      Although the exact numbers are not known, we know women are particularly vulnerable