WITHDRAWN: Predictors of Healthcare Mistreatment Among Transgender and Gender Diverse Individuals: Are There Different Patterns By Patient Race and Ethnicity?

Background and Purpose: Transgender and gender diverse (TGD) patients face stigma in healthcare. To develop racial and socially just interventions, social workers and other professionals need to understand which patient subgroups are most likely to experience mistreatment and the correlated psychosocial risks. The present study asks:

1. Which sociodemographic characteristics and psychosocial risk factors are associated with TGD patient mistreatment in healthcare in the past year?
2. How does identity documentation alignment (having a correct name and/or gender on one’s identification documents) relate to the likelihood of healthcare mistreatment in the past year?
3. Are there different patterns in the relationship between sociodemographic and psychosocial factors and TGD healthcare mistreatment by patient race and ethnicity?

Methods: We utilized de-identified data from the 2015 United States Transgender Survey (N=27,715). Healthcare mistreatment in the past year (e.g., refused care, verbally harassed) was the dichotomous dependent variable. Sociodemographic variables included gender identity, sexual orientation, race and ethnicity, age, Census region, disability status, etc. Psychosocial risk variables included: how many healthcare providers knew one was trans; having one’s correct name and gender listed on IDs; past year suicidal ideation and attempt; psychological distress; past year victimization; intimate partner violence victimization; and lifetime unwanted sexual contact and engagement in sex work. Bivariate chi-square analyses and t-tests examined associations between independent variables and healthcare mistreatment. The third research question was answered using multivariate logistic regression.

Results: Most sociodemographic variables and all psychosocial risk variables were significantly associated with healthcare mistreatment. Among those at greater risk for healthcare mistreatment were those who: were Alaska Native or American Indian (p<0.001); were more out to healthcare providers (p<0.001); reported greater psychological distress (p<0.001); reported suicidality in the past year (p<0.001); experienced past year victimization or lifetime IPV or unwanted sexual contact (p<0.001); or had only some IDs showing their correct name or gender (p<0.001).

Across all racial and ethnic groups, more providers knowing a person was TGD (AOR 1.30-1.70) and any past year victimization (AOR 1.69-2.96) were associated with mistreatment. Another common association was psychological distress, except for Latinx respondents. Black respondents in the South (AOR 1.81) and West (AOR 2.30) were at greater risk for healthcare mistreatment than those in the Northeast. Latinx respondents with only some IDs showing their correct name were more likely to experience healthcare mistreatment than those with no or all IDs showing a correct name (AOR 1.82).

Conclusions and Implications: There is a need for providers to understand how the interaction of TGD identities and marginalized racial and ethnic identities impact healthcare treatment of patients. For Latinx patients, name ID mismatch was associated with mistreatment, indicating a possible overlap between xenophobia and transphobia. Providers need to be taught skills like empathy, critical thinking, and rapport building. National and international health organizations need to put forth clear policies that affirm TGD and people of color, stop providers who are consistently harming these communities from practicing, and build a pipeline for the recruitment of medical practitioners who are TGD and people of color.