Barriers to Care Among Transgender and Gender Nonconforming Adults

Gonzales, Gilbert; Henning‐Smith, Carrie

doi:10.1111/1468-0009.12297

Cited by 218 publications

(173 citation statements)

References 29 publications

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“…24 Transgender people with multiple chronic conditions might be more likely to have an unmet need for caregiving; although 90% of the in-home long-term care are unpaid family or informal caregivers, 25 transgender people experience significant family rejection 23 and less social support. Although all transgender groups had a higher prevalence of no health insurance (largely consistent with a prior study), 26 few differences in preventive care utilization were observed, except for delaying care because of cost compared with CMs. This is consistent with prior research on preventive care in Medicare data 27 and could be attributed to more healthcare use among this group compared with cisgender peers.…”

Section: Discussionsupporting

confidence: 84%

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Health of Transgender Adults in the U.S., 2014–2016

Downing

Przedworski

2018

American Journal of Preventive Medicine

229

164

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Section: Discussionsupporting

confidence: 84%

“…These results differ from a prior estimate using the 2014-2015 BRFSS data that found GNC people reported delaying care because of cost and not having a primary care visit in the last year compared with CFs. 26 Research on how health access and insurance varies over time and place is critical.…”

Section: Discussionmentioning

confidence: 99%

Health of Transgender Adults in the U.S., 2014–2016

Downing

Przedworski

2018

American Journal of Preventive Medicine

229

164

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“…Further, these negative consequences for health are likely to be compounded for individuals from multiple minority backgrounds, such as LGBTQ racial/ethnic minorities or LGBTQ women . Transgender people, with their unique health concerns, may also face special health‐related vulnerabilities as a result of discrimination, including social and economic vulnerabilities that increase health risks . These effects are particularly alarming given that LGBTQ people are significantly less likely than non‐LGBTQ people to have health insurance and therefore may have less access to medical care that could mitigate the adverse health consequences of discrimination.…”

Section: Introductionmentioning

confidence: 99%

“…18,[25][26][27][28][29][30] Transgender people, with their unique health concerns, may also face special health-related vulnerabilities as a result of discrimination, including social and economic vulnerabilities that increase health risks. 31,32 These effects are particularly alarming given that…”

Section: Introductionmentioning

confidence: 99%

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Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans

Casey

Reisner

Findling

et al. 2019

Health Services Research

269

148

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Objective To examine reported experiences of discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults in the United States, which broadly contribute to poor health outcomes. Data Source and Study Design Data came from a national, probability‐based telephone survey of US adults, including 489 LGBTQ adults (282 non‐Hispanic whites and 201 racial/ethnic minorities), conducted January‐April 2017. Methods We calculated the percentages of LGBTQ adults reporting experiences of discrimination in health care and several other domains related to their sexual orientation and, for transgender adults, gender identity. We report these results overall, by race/ethnicity, and among transgender adults only. We used multivariable models to estimate adjusted odds of discrimination between racial/ethnic minority and white LGBTQ respondents. Principal Findings Experiences of interpersonal discrimination were common for LGBTQ adults, including slurs (57 percent), microaggressions (53 percent), sexual harassment (51 percent), violence (51 percent), and harassment regarding bathroom use (34 percent). More than one in six LGBTQ adults also reported avoiding health care due to anticipated discrimination (18 percent), including 22 percent of transgender adults, while 16 percent of LGBTQ adults reported discrimination in health care encounters. LGBTQ racial/ethnic minorities had statistically significantly higher odds than whites in reporting discrimination based on their LGBTQ identity when applying for jobs, when trying to vote or participate in politics, and interacting with the legal system Conclusions Discrimination is widely experienced by LGBTQ adults across health care and other domains, especially among racial/ethnic minorities. Policy and programmatic efforts are needed to reduce these negative experiences and their health impact on sexual and/or gender minority adults, particularly those who experience compounded forms of discrimination.

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Medicare Eligibility and Changes in Coverage, Access to Care, and Health by Sexual Orientation and Gender Identity

Gavulic,

Wallace

2024

JAMA Health Forum

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ImportanceMedicare provides nearly universal insurance coverage at age 65 years. However, how Medicare eligibility affects disparities in health insurance coverage, access to care, and health status among individuals by sexual orientation and gender identity is poorly understood.ObjectiveTo assess the association of Medicare eligibility with disparities in health insurance coverage, access to care, and self-reported health status among individuals by sexual orientation and by gender identity.Design, Setting, and ParticipantsThis cross-sectional study used the age discontinuity for Medicare eligibility at age 65 years to isolate the association of Medicare with health insurance coverage, access to care, and self-reported health status, by their sexual orientation and by their gender identity. Data were collected from the Behavioral Risk Factor Surveillance System for respondents from 51 to 79 years old from 2014 to 2021. Data analysis was performed from September 2022 to April 2023.ExposuresMedicare eligibility at age 65 years.Main Outcomes and MeasuresProportions of respondents with health insurance coverage, usual source of care, cost barriers to care, influenza vaccination, and self-reported health status.ResultsThe study population included 927 952 individuals (mean [SD] age, 64.4 [7.7] years; 524 972 [56.6%] females and 402 670 [43.4%] males), of whom 28 077 (3.03%) identified as a sexual minority—lesbian, gay, bisexual, or another sexual minority identity (LGB+) and 3286 (0.35%) as transgender or gender diverse. Respondents who identified as heterosexual had greater improvements at age 65 years in insurance coverage (4.2 percentage points [pp]; 95% CI, 4.0-4.4 pp) than those who identified as LGB+ (3.6 pp; 95% CI, 2.3-4.8 pp), except when the analysis was limited to a subsample of married respondents. For access to care, improvements in usual source of care, cost barriers to care, and influenza vaccination were larger at age 65 years for heterosexual respondents compared with LGB+ respondents, although confidence intervals were overlapping and less precise for LGB+ individuals. For self-reported health status, the analyses found larger improvements at age 65 years for LGB+ respondents compared with heterosexual respondents. There was considerable heterogeneity by state in disparities by sexual orientation among individuals who were nearly eligible for Medicare (close to 65 years old), with the US South and Central states demonstrating the highest disparities. Among the top-10 highest-disparities states, Medicare eligibility was associated with greater increases in coverage (6.7 pp vs 5.0 pp) and access to a usual source of care (1.4 pp vs 0.6 pp) for LGB+ respondents compared with heterosexual respondents.Conclusions and RelevanceThe findings of this cross-sectional study indicate that Medicare eligibility was not associated with consistently greater improvements in health insurance coverage and access to care among LGBTQI+ individuals compared with heterosexual and/or cisgender individuals. However, among sexual minority individuals, Medicare may be associated with closing gaps in self-reported health status, and among states with the highest disparities, it may improve health insurance coverage, access to care, and self-reported health status.

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Barriers to Care Among Transgender and Gender Nonconforming Adults

Abstract: Transgender and GNC adults face barriers to health care that may be due to a variety of reasons, including discrimination in health care, health insurance policies, employment, and public policy or lack of awareness among health care providers on transgender-related health issues.

Cited by 218 publications

References 29 publications

Health of Transgender Adults in the U.S., 2014–2016

Health of Transgender Adults in the U.S., 2014–2016

Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans

Medicare Eligibility and Changes in Coverage, Access to Care, and Health by Sexual Orientation and Gender Identity

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