Discrimination and Delayed Health Care Among Transgender Women and Men

Jaffee, Kim D.; Shires, Deirdre A.; Stroumsa, Daphna

doi:10.1097/mlr.0000000000000583

Cited by 290 publications

(153 citation statements)

References 21 publications

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“…In another study, African American sexual minority women who attributed their negative experiences in a healthcare setting to multifactorial discrimination decreased their health care utilization following the negative experience [54]. Among minority populations, discrimination during health care is significantly associated with delayed care and stopped treatment [55, 56]. Disengagement with the health care system due to negative patient-provider interactions, resulting from discrimination, may partially explain poor health outcomes across marginalized communities [57–59].…”

Section: Discussionmentioning

confidence: 99%

Multifactorial discrimination as a fundamental cause of mental health inequities

Khan

Ilcisin

Saxton

2017

Int J Equity Health

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BackgroundThe theory of fundamental causes explains why health disparities persist over time, even as risk factors, mechanisms, and diseases change. Using an intersectional framework, we evaluated multifactorial discrimination as a fundamental cause of mental health disparities.MethodsUsing baseline data from the Project STRIDE: Stress, Identity, and Mental Health study, we examined the health effects of discrimination among individuals who self-identified as lesbian, gay, or bisexual. We used logistic and linear regression to assess whether multifactorial discrimination met the four criteria designating a fundamental cause, namely that the cause: 1) influences multiple health outcomes, 2) affects multiple risk factors, 3) involves access to resources that can be leveraged to reduce consequences of disease, and 4) reproduces itself in varied contexts through changing mechanisms.ResultsMultifactorial discrimination predicted high depression scores, psychological well-being, and substance use disorder diagnosis. Discrimination was positively associated with risk factors for high depression scores: chronic strain and total number of stressful life events. Discrimination was associated with significantly lower levels of mastery and self-esteem, protective factors for depressive symptomatology. Even after controlling for risk factors, discrimination remained a significant predictor for high depression scores. Among subjects with low depression scores, multifactorial discrimination also predicted anxiety and aggregate mental health scores.ConclusionsMultifactorial discrimination should be considered a fundamental cause of mental health inequities and may be an important cause of broad health disparities among populations with intersecting social identities.

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Section: Discussionmentioning

confidence: 99%

Multifactorial discrimination as a fundamental cause of mental health inequities

Khan

Ilcisin

Saxton

2017

Int J Equity Health

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“…Access to health care is influenced by gender identity; differences exist between transgender subgroups in their experience of health care access barriers and health care utilization (Gonzales & Henning-Smith, 2017). For example, studies have revealed that trans men have a greater tendency than trans women to delay health care due to the fear of discrimination (Cruz, 2014;Jaffee, Shires, & Stroumsa, 2016). Furthermore, researchers have identified the increased disadvantages of transgender individuals who belong to more than one marginalized community (e.g., ethnic/racial minority, low income and visually non-conforming), as these individuals experience even more prevalent discrimination and substandard care (Bradford et al, 2013;Grant et al, 2011;Jaffee et al, 2016;Kattari, Walls, Whitfield, & Langenderfer-Magruder, 2015Lambda Legal, 2010;Shires & Jaffee 2015).…”

Section: Discussionmentioning

confidence: 99%

Profound health-care discrimination experienced by transgender people: rapid systematic review

Kcomt

2018

Social Work in Health Care

131

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Transgender people experience interpersonal and structural barriers which prevent them from accessing culturally and medically competent health care. This rapid systematic review examined the prevalence of health care discrimination among transgender people in the U.S. and drew comparisons with sexual minority samples and the general U.S. population. Eight primary studies with 35 prevalence estimates were analyzed. The transgender population experience profound rates of discrimination within the U.S. health care system. Compared to sexual minorities, transgender participants appear to be more compromised in their access to health care. Service providers must change structural inequities which contribute to transgender people's invisibility.

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“…Across numerous studies of transgender women, discrimination in accessing healthcare services has been linked to healthcare delay and avoidance and overall worse health outcomes, including lack of preventative healthcare (52–53). While the aforementioned increase in access to healthcare insurance in Study 2 was a promising finding, the concurrent higher prevalence of reported healthcare discrimination, as well as the decrease in gender-related surgeries, with the exception of genital reconstruction (i.e., vaginoplasty), highlighted the continued need for transgender-specific clinical and cultural competency trainings for healthcare providers.…”

Section: Discussionmentioning

confidence: 99%

Health Disparities, Risk Behaviors and Healthcare Utilization Among Transgender Women in Los Angeles County: A Comparison from 1998–1999 to 2015–2016

et al. 2018

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Data from two studies of transgender women in Los Angeles County that used the same methodology and survey assessment (Study 1: 1998–1999, N=244; Study 2: 2015–2016, N=271), compared structural determinants of health, HIV/STI prevalence, HIV risk behaviors, substance use, gender confirmation procedures, and perceived discrimination and harassment/abuse across a 17-year time period. Findings demonstrated that participants in the latter study reported significantly higher access to healthcare insurance and prescription hormones. However, participants in the latter study also reported lower levels of income; and, elevated prevalence of homelessness, HIV and lifetime STIs, receptive condomless anal intercourse with casual partner(s), and reported physical harassment/abuse. Given the timeframe of these results, these findings elucidate specific areas of transgender women’s health and risk profiles that improved or worsened across 17 years. While healthcare access has improved, transgender women continue to face significant barriers to good health, indicating the need for increased attention to this population.

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Discrimination and Delayed Health Care Among Transgender Women and Men

Cited by 290 publications

References 21 publications

Multifactorial discrimination as a fundamental cause of mental health inequities

Multifactorial discrimination as a fundamental cause of mental health inequities

Profound health-care discrimination experienced by transgender people: rapid systematic review

Health Disparities, Risk Behaviors and Healthcare Utilization Among Transgender Women in Los Angeles County: A Comparison from 1998–1999 to 2015–2016

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