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Operationalizing and analyzing 2-step gender identity questions: Methodological and ethical considerations
Kacie M Kidd1, Gina M Sequeira2, Scott D Rothenberger3
1Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
Journal of the American Medical Informatics Association : JAMIA
|September 2, 2021
Summary
Analyzing two-step gender identity questions is crucial for understanding suicidal ideation among gender-diverse youth (GDY). Different analysis methods impact results, highlighting the need for careful data interpretation in healthcare settings.
Area of Science:
- Health Informatics
- Public Health Research
- Sociology
Background:
- Integrating gender identity questions into electronic health records (EHRs) is vital for optimizing care for gender-diverse individuals.
- Standardized methods for analyzing this data are currently lacking, impacting research and clinical practice.
- Two-step gender identity questions offer a more nuanced approach to data collection.
Purpose of the Study:
- To evaluate different analytical strategies for two-step gender identity questions.
- To assess the impact of these strategies on the reported rates of suicidal ideation among gender-diverse youth (GDY).
- To inform best practices for data analysis in clinical informatics and research.
Main Methods:
- A regional Youth Risk Behavior Survey was utilized, including a two-step gender identity question.
- Three distinct gender measurement strategies (GMSs) were applied: pooling all GDY, grouping by sex assigned at birth, and categorizing by binary/nonbinary identities.
- Mixed-effects logistic regression analyzed the association between gender identity categories and suicidal ideation.
Main Results:
- Gender-diverse youth (GDY) consistently reported higher odds of suicidal ideation compared to cisgender girls (OR range: 1.6-2.9) and cisgender boys (OR range: 2.1-5.0).
- These findings remained significant across all three GMSs, indicating robust associations.
- 8.3% of the 3010 participants identified as GDY.
Conclusions:
- The analysis of two-step gender identity questions significantly influences study outcomes and interpretation.
- Clinical informatics can leverage these questions in EHRs to improve care and research for gender-diverse populations.
- Tailored analyses reflecting the unique experiences of GDY are essential for accurate data representation and support.
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