Race and Ethnic Disparities In Healthcare Access Among Transgender Individuals

Background and Purpose:

Access to health care remains a fundamental necessity for all individuals. However, people from racial and ethnic minority groups continue to face numerous barriers that impact their quality of life and life expectancy (Tzenios, 2019). These barriers are exacerbated when they also have an intersectional identity of being transgender, as they may face additional challenges such as discrimination in healthcare settings, a lack of understanding of transgender health needs, and policies that make them feel unsafe (Safer et al., 2016). However, there may be differences in healthcare access among transgender populations that also vary by race and ethnicity, and these have largely been unexamined. This current study seeks to address this research gap, exploring factors that contribute to differences in accessing healthcare among transgender individuals within and across racial and ethnic groups.

Methods:

This study employed a cross-sectional secondary analysis of data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS), a national health surveillance survey conducted annually by the U.S. Centers for Disease Control and Prevention (CDC). Data analysis used descriptive statistics to examine differences within each racial and ethnic group regarding whether or not an individual had accessed medical care in the past 12 months and key factors including insurance coverage, cost barriers to care, having a personal doctor, general health status, and mental health, while multivariate logistic regression explored differences across racial groups related to these factors and access to care.

Results:

White transgender participants comprised the largest proportion of the sample (n = 1,240), followed by Hispanic (n = 256), Other Race (n = 131), Black (n = 79), Asian (n = 65), and Native American respondents (n = 31). The regression model was statistically significant (χ²(9) = 335.90, p < .001), indicating that this set of predictors reliably distinguished between respondents who did and did not access care. Having a personal doctor emerged as the strongest predictor. Respondents with a personal doctor were more than eight times as likely to have accessed care compared to those without one (OR = 8.28, 95% CI [6.05, 11.32], p < .001). Experiencing cost-related barriers to care was associated with substantially lower odds of obtaining care (OR = 0.51, 95% CI [0.38, 0.68], p < .001). Those reporting cost barriers to care were about half as likely to obtain care as those who reported no cost barriers. Finally, race was not a predictive factor among these transgender individuals related to accessing healthcare services.

Conclusions and Implications:

Within this population of transgender individuals, there was not a lot of difference in their health care experiences based on their race and ethnicity. Rather, their identity as transgender appears to supersede their racial and ethnic identities. These insights have important implications for policy and practice. To address contributing factors, interventions should prioritize expanding access to personal doctors through telemedicine, training providers on the intersections of race, ethnicity, and gender identities and offering incentives to serve underserved racial/ethnic groups (Mintz et al., 2022; Yu et al., 2023).