Healthcare avoidance due to anticipated discrimination among transgender people: A call to create trans-affirmative environments
Healthcare avoidance due to anticipated discrimination among transgender people: A call to create trans-affirmative environments
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DOI：
10.1016/j.ssmph.2020.100608
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发表时间：
2020-08-01
影响因子：
4.7
通讯作者：
McCabe, Sean Esteban
中科院分区：
文献类型：
--
作者：
Kcomt, Luisa;Gorey, Kevin M.;McCabe, Sean Esteban
跨性别者在获得医疗保健方面遇到人际和结构性障碍，导致他们推迟或避免医疗保健，这可能导致不良的身心健康结果。使用2015年美国跨性别调查，这项研究检查了由于25至64岁的跨性别成年人（N = 19，157）的预期歧视而避免医疗保健。进行多变量logistic回归分析，以检验性别认同/表达、社会人口统计学和跨性别特异性因素是否与医疗回避相关。近四分之一的样本（22.8%）由于预期的歧视而避免医疗保健。相对于跨性别女性，跨性别男性避免医疗保健的几率增加（AOR = 1.32，95% CI = 1.21-1.45）。生活贫困（AOR = 1.52，95%CI = 1.40-1.65）和视力不一致（AOR = 1.48，95%CI = 1.33-1.66）是显著的危险因素。拥有健康保险（AOR = 0.87，95%CI = 0.79-0.96）和披露跨性别身份（AOR = 0.77，95%CI = 0.68-0.87）对避免医疗保健具有保护作用。性别认同/表达与健康保险的一个显着的相互作用被发现，有健康保险缓和性别认同/表达和医疗回避之间的关联。提供者应考虑性别差异、社会人口和变性人特有的因素，以改善变性人社区获得服务的机会。应采用多层次和多方面的办法，在卫生系统中创造安全、跨性别的积极环境。
Transgender people encounter interpersonal and structural barriers to healthcare access that contribute to their postponement or avoidance of healthcare, which can lead to poor physical and mental health outcomes. Using the 2015 U.S. Transgender Survey, this study examined avoidance of healthcare due to anticipated discrimination among transgender adults aged 25 to 64 (N = 19,157). Multivariable logistic regression analysis was conducted to test whether gender identity/expression, socio-demographic, and transgender-specific factors were associated with healthcare avoidance. Almost one-quarter of the sample (22.8%) avoided healthcare due to anticipated discrimination. Transgender men had increased odds of healthcare avoidance (AOR = 1.32, 95% CI = 1.21-1.45) relative to transgender women. Living in poverty (AOR = 1.52, 95% CI = 1.40-1.65) and visual non-conformity (AOR = 1.48, 95% CI = 1.33-1.66) were significant risk factors. Having health insurance (AOR = 0.87, 95% CI = 0.79-0.96) and disclosure of transgender identity (AOR = 0.77, 95% CI = 0.68-0.87) were protective against healthcare avoidance. A significant interaction of gender identity/expression with health insurance was found; having health insurance moderated the association between gender identity/expression and healthcare avoidance. Providers should consider gender differences, socio-demographic, and transgenderspecific factors to improve accessibility of services to transgender communities. A multi-level and multifaceted approach should be used to create safe, trans-affirmative environments in health systems.