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Study shows gender identity plays key role in access to care

Dec. 14, 2017, 10:11 AM

A new large-scale study examining barriers to healthcare through the lens of gender identity finds that transgender men and women tend to fare poorly. The study, by researchers at Vanderbilt University and the University of Minnesota, appears in The Milbank Quarterly.

The study used federal survey data from 315,893 respondents living in 27 states.

Gilbert Gonzales, PhD, MHA

“While previous studies have made inroads in understanding how gender identity plays into healthcare equity, we’re only beginning to benefit from random sampling of patient populations at a truly large scale. And in this study, we find some striking disparities that are very concerning,” said Gilbert Gonzales, PhD, MHA, assistant professor of Health Policy at Vanderbilt.

The researchers used data from the Behavioral Risk Factor Surveillance System, an annual health survey of more than 400,000 randomly selected adults, conducted by telephone by the Centers for Disease Control and Prevention in partnership with all 50 states.

In the 2014–2015 edition of the survey, 27 states and the Territory of Guam included an optional set of questions about sexual orientation and gender identity.

This furnished researchers with responses from 183,370 cisgender women, 131,080 cisgender men, 724 transgender women, 449 transgender men and 270 gender nonconforming adults.

Cisgender refers to people whose gender corresponds to their sex assigned at birth; transgender refers to people whose sense of personal identity and gender doesn’t correspond to their sex assigned at birth (a transgender woman, for example, is someone who has transitioned from male to female); gender nonconforming (GNC) refers more broadly to behavior or gender expression that doesn’t match gender norms.

The researchers used responses from cisgender women as a benchmark for identifying disparities. After accounting for demographic and socioeconomic differences, compared to cisgender women:

  • Transgender women were 60 percent more likely to have no health insurance;
  • Transgender men were twice as likely to have no health insurance and 84 percent more likely to have no usual source of care;
  • GNC adults were 93 percent more likely to report unmet medical care needs due to cost and 141 percent more likely to have had no routine check-up in the previous year;
  • Cisgender men were 35 percent more likely to have no health insurance, 48 percent more likely to have no routine check-up and 69 percent more likely to have no usual source of care.

“We need to eliminate healthcare barriers for all groups in order to achieve health equity, and to that end we need better understanding of the added challenges faced by transgender and GNC populations,” Gonzales said. “As a first step toward understanding and addressing disparities, gender identity and sexual orientation need to be routinely included in health surveys and electronic health records.”

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