Factors Associated with Delayed Needed Health Care Due to Discrimination of Transgender Individuals
Delayed medical care is costly to the US healthcare system and results in overutilization of ER’s and contributes to high levels of morbidity and mortality. Discrimination is one factor that influences healthcare utilization. The transgender community is at high risk of discrimination in healthcare. Transgender individuals report experiencing ridicule and are often ignored in medical settings. Physician lack of training in transgender health complicates clinical management of transgender patients. This study will use Anderson’s behavioral model of health services utilization to examine the relationship between postponed needed health care due to discrimination, and providers lack of transgender health knowledge, controlling for predisposing and enabling factors.
Methods
The 2008 National Transgender Discrimination Survey (N=4,407) was used to assess: 1) the proportion of transgender individuals who delayed or did not seek care for an illness or injury due to discrimination; 2) the association of delayed sick/injury care, and lack of provider transgender health knowledge, controlling for enabling and predisposing factors. Independent variables included predisposing factors (PF) such as transgender status (female-to-male vs. male-to-female), medical transition status, gender presentation, race/ethnicity, age, sexual orientation, and education. The enabling factors (EF) were income, health insurance, and employment status. The outcome variable was delayed neededmedical care for injury/illness due to discrimination. Lack of provider healthcare knowledge (LPK) was derived from a survey item asking if they had to teach their health provider about transgender people to get appropriate care. Descriptive analyses and chi-square statistics were used to test bivariate associations. A three step logistic regression model was used to test: 1) PF; 2) PF + EF; and 3) PF + EF + LPK.
Results
Overall, 30.8 percent of transgender participants postponed or did not seek needed healthcare due to discrimination. Bivariate analysis of the relationship between delayed needed care and lack of provider knowledge found those who had to teach health providers about transgender healthcare were three times more likely to have postponed or not sought needed medical care compared to those who did not teach their healthcare provider (43.2% and 14.1%, respectively). Each of the logistic regression models significantly predicted postponed needed healthcare due to discrimination (p<.0001). Model 3 (PF, EF, and LPK) was the best fit for predicting delayed needed medical care due to discrimination (p<.0001, R2 = .222). Respondents indicating they had to teach healthcare providers about transgender health (OR=4.13), were FTM (OR=1.73), multiracial (OR=1.89), Hispanic (OR=1.57), queer (OR=1.40), had a graduate degree (OR=1.47), and were uninsured (OR=1.28) were more likely to delay needed healthcare due to discrimination.
Conclusions and Implications
One-third of transgender respondents postponed or did not seek needed care for illness or injury due to healthcare discrimination. Transgender patients who teach their medical providers about their healthcare needs are significantly more likely to postpone or not seek care when most needed. The Affordable Care Act has created integrated healthcare models that have the potential to increase social work advocacy and diversity training designed to increase knowledge about transgender needs within medical settings.