Kamalpreet Hara, MBBS1, Rachel Canning, BS1, Lindsey Philpot, PhD, MPH1, Evdokiya Knyazhanskaya, 2, Jordan Richardson, 2, Jean Fox, MD1, Douglas A. Simonetto, MD3, Victor Chedid, MD, MS1 1Mayo Clinic, Rochester, MN; 2Mayo Clinic, Alix School of Medicine, Rochester, MN; 3Mayo Clinic School of Graduate Medical Education, Rochester, MN
Introduction: As of 2022, 7.1% of adults in the United States identify as LGBTQ+. It is reported that LGBTQ+ individuals have lower rates of colorectal cancer (CRC) screening but the barriers are not well understood. Furthermore, little is known about prevalence of GI symptoms among the LGBTQ+ community.
Methods: At Rochester Pride 2022, attendees completed an anonymous online/paper survey to assess frequency of common GI symptoms, CRC screening awareness and reasons for not attending CRC screening. Odds ratios were calculated using logistic regression for dichotomized outcomes and general linearized models for categorical outcomes after adjusting for age. Outcomes were considered significant when the 95% confidence intervals do not span the null and p< 0.05.
Results: 132 respondents completed the survey (Table 1). LGBTQ+ respondents (N=89) were younger than straight respondents (N=43) and had higher prevalence of cumulative GI symptoms. In the past 6 months, 43.4% of LGBTQ+ individuals reported GERD, 42.1% had experienced abdominal pain and diarrhea, 30.3% with constipation, 28.9% with bloating and 23.7% with nausea/vomiting. In general, as number of symptoms increase by one, an individual was at 33% increased odds to seek/have sought care (OR 1.332; 95% CI 1.26 – 1.730). LGBTQ+ individuals are at lower odds to seek care compared to non-LGBTQ+ individuals, though not statistically significant (OR 0.855; 95% CI 0.257 – 2.850). Within the LGBTQ+ community, those with more symptoms are also of increased odds to seek care, though not statistically significant (OR 1.127; 95% CI 0.0833 – 1.526) while within the non-LGBTQ+ community, those with more symptoms are much at higher odds to seek care (OR 4.413; 95% CI 1.305 – 14.92). LGBTQ+ individuals were familiar but less comfortable with CRC screening tests (p< 0.0049). 68.6% of LGBTQ+ individuals were either uncomfortable or neutral towards a colonoscopy compared to 39% non-LGBTQ+ individuals (p= 0.136). Fear of discrimination at healthcare setting (p< 0.0017) and at workplace or socially (p< 0.0110) were stated reasons to avoid healthcare screenings.
Discussion: This survey highlights that LGBTQ+ individuals tend to delay care despite a higher burden of common GI symptoms. Furthermore, LGBTQ+ individuals are less comfortable with CRC screening tests with fear of discrimination being the leading reason. Further studies are required to identify barriers to care in the LGBTQ+ community.
Heterosexual / Straight (N=43)
LGBT+ (N=89)
Total (N=132)
p value
Age
Missing
18-25
26-35
36-45
46-55
56-55
66-75
76+
0 (0.0%)
4 (9.3%)
12 (27.9%)
8 (18.6%)
8 (18.6%)
6 (14.0%)
4 (9.3%)
1 (2.3%)
1 (1.1%)
37 (41.6%)
28 (31.5%)
10 (11.2%)
6 (6.7%)
5 (5.6%)
1 (1.1%)
1 (1.1%)
1 (0.8%)
41 (31.1%)
40 (30.3%)
18 (13.6%)
14 (10.6%)
11 (8.3%)
5 (3.8%)
2 (1.5%)
Race
Missing
White
Black / African American
Asian
Other
1 (2.3%)
37 (86.0%)
2 (4.7%)
3 (7.0%)
0 (0.0%)
0 (0.0%)
79 (88.8%)
0 (0.0%)
4 (4.5%)
6 (6.7%)
1 (0.8%)
116 (87.9%)
2 (1.5%)
7 (5.3%)
6 (4.5%)
Education Level
Missing
Less than high school
High school graduate
Some college
2-year degree
4-year degree
Professional degree
Doctorate
Prefer not to answer
1 (2.3%)
0 (0.0%)
1 (2.3%)
5 (11.6%)
5 (11.6%)
8 (18.6%)
14 (32.6%)
8 (18.6%)
1 (2.3%)
0 (0.0%)
8 (9.0%)
8 (9.0%)
28 (31.5%)
6 (6.7%)
20 (22.5%)
11 (12.4%)
8 (9.0%)
0 (0.0%)
1 (0.8%)
8 (6.1%)
9 (6.8%)
33 (25.0%)
11 (8.3%)
28 (21.2%)
25 (18.9%)
16 (12.1%)
1 (0.8%)
Relationship Status
Missing
Single, never married
Marriage or partnered in a marriage-like relationship
Separated
Divorced
Other
Prefer not to answer
2 (4.7%)
11 (25.6%)
25 (58.1%)
1 (2.3%)
4 (9.3%)
0 (0.0%)
0 (0.0%)
1 (1.1%)
49 (55.1%)
25 (28.1%)
1 (1.1%)
3 (3.4%)
6 (6.7%)
3 (3.4%)
3 (2.3%)
60 (45.5%)
50 (37.9%)
2 (1.5%)
7 (5.3%)
6 (4.5%)
3 (2.3%)
GI Symptoms experienced in the past 6 months
Abdominal or belly pain
Difficulty swallowing
Bowel incontinence
Heartburn/Acid reflux/
gastroesophageal reflux
Bloating or swelling in belly
Diarrhea
Constipation
Nausea/Vomiting
None
Other
12 (32.4%)
0 (0.0%)
1 (2.7%)
12 (32.4%)
5 (13.5%)
7 (18.9%)
9 (24.3%)
2 (5.4%)
15 (40.5%)
0 (0.0%)
32 (42.1%)
4 (5.3%)
10 (13.2%)
33 (43.4%)
22 (28.9%)
32 (42.1%)
23 (30.3%)
18 (23.7%)
21 (27.6%)
1 (1.3%)
44 (38.9%)
4 (3.5%)
11 (9.7%)
45 (39.8%)
27 (23.9%)
39 (34.5%)
32 (28.3%)
20 (17.7%)
36 (31.9%)
1 (0.9%)
0.7878
0.9494
0.1514
0.3481
0.1437
0.1770
0.9547
0.3219
0.3177
0.9244
Did you see or are you planning to see a gastroenterologist (GI/gut doctor) for any of your gastrointestinal (GI) symptoms in the past or coming 6 months?
0.5788
Yes (yes in the past 6 months/ in the coming 6 months)
No (No, No GI symptoms, If not please let us know the reason)
7
26
17
52
24
78
General familiarity with colorectal screening tests*
0.0829
Missing
Not familiar at all/Slightly familiar
Moderately familiar
Very familiar/Extremely familiar
3
11 (27.5%)
10 (25.0%)
19 (47.5%)
7
40 (50.0%)
26 (32.5%)
14 (17.5%)
10
51 (42.5%)
36 (30.0%)
33 (27.5%)
How comfortable are you with colonoscopy?
0.1362
Missing
Extremely / Somewhat uncomfortable
Neutral
Extremely / Somewhat comfortable
2
10 (24.4%)
6 (14.6%)
25 (61.0%)
6
27 (32.5%)
30 (36.1%)
26 (31.3%)
8
27 (29.9%)
36 (29.0%)
51 (41.1%)
General comfort with colorectal screening tests*
0.0049
Missing
Extremely / Somewhat uncomfortable
Neutral
Extremely / Somewhat comfortable
4
3 (7.7%)
12 (30.8%)
24 (61.5%)
12
13 (16.9%)
47 (61.0%)
17 (22.1%)
16
15 (13.8%)
59 (50.9%)
41 (35.3%)
Reasons for not attending health screening tests:
Do not see a reason for going since they feel they are healthy
0.9381
Missing
Always / Sometimes applies to me
Never applies to me
1
24 (57.1%)
18 (42.9%)
9
55 (68.8%)
25 (31.3%)
10
79 (64.8%)
43 (35.2%)
The doctor did not recommend health screening tests
0.9763
Missing
Always / Sometimes applies to me
Never applies to me
2
21 (51.2%)
20 (48.8%)
8
50 (61.7%)
31 (38.3%)
10
71 (58.2%)
51 (41.8%)
Health screenings are expensive
0.3022
Missing
Always / Sometimes applies to me
Never applies to me
2
21 (51.2%)
20 (48.8%)
9
52 (65.0%)
28 (35.0%)
11
73 (60.3%)
48 (39.7%)
Health screening tests are not routine
0.4062
Missing
Always / Sometimes applies to me
Never applies to me
4
23 (59.0%)
16 (41.0%)
9
59 (73.8%)
21 (26.3%)
13
82 (68.9%)
37 (31.1%)
Going for a health screening test is a hassle due to busy schedule
0.6348
Missing
Always / Sometimes applies to me
Never applies to me
2
25 (61.0%)
16 (39.0%)
9
59 (73.8%)
21 (26.3%)
11
84 (69.4%)
37 (30.6%)
Health insurance does not cover screening
0.7104
Missing
Always / Sometimes applies to me
Never applies to me
4
16 (41.0%)
23 (59.0%)
9
43 (53.8%)
37 (46.3%)
13
59 (49.6%)
60 (50.4%)
Fear of discrimination at workplace or socially if diagnosed with disease.
0.0110
Missing
Always / Sometimes applies to me
Never applies to me
3
2 (5.0%)
38 (95.0%)
9
28 (35.0%)
52 (65.0%)
12
30 (25.0%)
90 (75.0%)
Fear of discrimination at the healthcare setting due to LGBTQIA+ status.
0.0017
Missing
Always / Sometimes applies to me
Never applies to me
3
1 (2.5%)
39 (97.5%)
10
35 (44.3%)
44 (55.7%)
13
36 (30.3%)
83 (69.7%)
Table: Table 1. Demographics, Familiarity and Comfort with Various Colorectal Cancer Screening Modalities, and Reasons for not Attending Health Screening in Rochester Pride 2022 Participants *colorectal screening tests included colonoscopy, stool based tests, flexible sigmoidoscopy and CT colonography
Disclosures:
Kamalpreet Hara indicated no relevant financial relationships.
Rachel Canning indicated no relevant financial relationships.
Lindsey Philpot indicated no relevant financial relationships.
Evdokiya Knyazhanskaya indicated no relevant financial relationships.
Jordan Richardson indicated no relevant financial relationships.
Jean Fox indicated no relevant financial relationships.
Douglas Simonetto indicated no relevant financial relationships.
Victor Chedid indicated no relevant financial relationships.
Kamalpreet Hara, MBBS1, Rachel Canning, BS1, Lindsey Philpot, PhD, MPH1, Evdokiya Knyazhanskaya, 2, Jordan Richardson, 2, Jean Fox, MD1, Douglas A. Simonetto, MD3, Victor Chedid, MD, MS1. E0629 - Health Disparities in Gastroenterology in LGBTQ+ Individuals: A Rochester Pride 2022 Survey, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
