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In this issue of OEM, Siegrist et al report on new findings on stress and cardiovascular risk from the CONSTANCES study,1 which is a prospective cohort of 48 383 individuals recruited through the French Social Security system. Reading this paper brought some thoughts on inclusion and how trans and gender-diverse individuals were dealt with in a study of that size. Indeed, this study reports data only on women and men, but no data were reported for gender non-conforming individuals. Reliable data are lacking on the exact number of non-binary individuals in the general population in France. A 2016 meta-analysis calculated a meta-prevalence estimate of self-reported transgender identity of 0.36% (95% CI 0.14% to 0.57%) based on studies from the USA, the Netherlands, Taiwan and Belgium.2 If we applied such an estimate to the numbers provided by Siegrist et al, we could expect they would be around 174 individuals. During the peer-review process with OEM, Siegrist et al expressed hope that such data would be available in further publications on CONSTANCES. It would be indeed very helpful and important.
Why is that important to think of these 174 individuals (possibly more), in a study of more than 48 000 participants? Some reasons are externally driven: we …
Contributors QVD-M is the sole author of the commentary.
Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests QVD-M is an associate editor for OEM.
Provenance and peer review Commissioned; internally peer reviewed.