Transgender people more likely than cisgender people to avoid health care due to cost

Two studies from the Williams Institute at UCLA School of Law provide new insight into the state of transgender health and accessing health care.

The first study shows that despite the high level of insurance coverage, transgender people are more likely than cisgender people to have avoided care due to cost. An estimated 90% of transgender people report having health insurance coverage, but one-third (33%) said they avoided health care due to cost in the past year, compared to 15% of cisgender people. In addition, only 64% of transgender people accessed specialized transgender-related health care, but many more (82%) said that they would like to access such care.

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The second study underscores the need for quality health care for transgender people. Results show that transgender people had greater odds of discrimination, psychological distress, and adverse childhood experiences—stressors that were associated with increased odds of a cardiovascular condition. A greater proportion of transgender than cisgender people were current smokers, which increases the risk of cardiovascular disease. Transgender women also have more than three times greater risk of venous thromboembolism, compared to cisgender women.

New studies reveal transgender people put off accessing health care due to cost

Both studies used data from TransPop, the first nationally representative survey of transgender people in the United States.

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“Even with proper health insurance, transgender people face barriers to good quality and specialized care," said study co-author Ilan H. Meyer, Principal Investigator of the TransPop study and Distinguished Scholar of Public Policy at the Williams Institute. “These studies showed the role of minority stress in cardiovascular disease disparities between transgender and cisgender people. Access to high-quality culturally responsive transgender care is essential for reducing such health disparities."

KEY FINDINGS:

Healthcare access
Transgender nonbinary people were more likely to have avoided care due to cost compared to transgender women and men.Only 56% of transgender people overall had a transgender-related health care provider. Fewer nonbinary people accessed transgender-related health care.Of transgender participants, 82% said they would like to access an LGBT or transgender-specific clinic or provider. But 64% of transgender people had not been to an LGBT or transgender-specific clinic or provider over the five-year period prior to the interview.Nonbinary transgender people were less likely to have been to an LGBT or transgender-specific clinic or provider over the five-year period than transgender men or transgender women.

Health outcomes
Transgender people had more poor physical health days per month (8 days) than cisgender people (4 days).Transgender people experienced greater numbers of poor mental health days per month (15 days) compared to cisgender people (6 days).Transgender people were more likely to report having HIV, other sexually transmitted infections, emphysema, ulcers, liver disease, and sleep disorders than cisgender people.

Cardiovascular conditions
The study found no differences between cisgender and transgender participants in cardiovascular disease overall. But transgender women were at more than three times greater risk of venous thromboembolism (VTE) compared to cisgender women.There was little difference between cisgender and transgender people in having ever smoked tobacco cigarettes, but a greater proportion of transgender people were current smokers.Transgender people had greater odds of everyday discrimination, psychological distress, and adverse childhood experiences.Among transgender individuals, exposure to adverse childhood experiences and psychological distress were associated with increased odds of smoking, a risk for many adverse health conditions.“Our findings add to a growing body of research examining the cumulative burden of minority stress and discrimination on a person's mental and physical state. Stress is a driver of chronic inflammation, which elevates the risk for cardiovascular disease," said study author Tonia Poteat, Associate Professor of Social Medicine at the University of North Carolina. “Additional research on the pathways by which psychosocial factors affect cardiovascular health in transgender people is needed."

“Our study found that both transgender and cisgender people were equally likely to have a personal health care provider and a place to go for health care, and, in contrast to previous studies, feel satisfied by the health care they received," said study author Jamie L. Feldman, Associate Professor at the University of Minnesota Medical School. “However, improved training and policies will ensure access for transgender people to knowledgeable health care providers."

ABOUT THE STUDIES

The TransPop study was supported by the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (R01HD090468). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

About The Williams Institute
The Williams Institute at UCLA School of Law, a think tank on sexual orientation and gender identity law and public policy, is dedicated to conducting rigorous, independent research with real-world relevance.

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