Geographic and Individual Differences in Healthcare Access for US Transgender Adults: A Multilevel Analysis
Geographic and Individual Differences in Healthcare Access for US Transgender Adults: A Multilevel Analysis
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DOI：
10.1089/lgbt.2016.0044
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发表时间：
2016-12-01
期刊：
影响因子：
4.8
通讯作者：
Reisner, Sari L.
中科院分区：
文献类型：
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作者：
Hughto, Jaclyn M. White;Murchison, Gabriel R.;Reisner, Sari L.
目的：确定与美国跨性别人群医疗保健可及性相关的地理和个人因素。方法：利用5831名美国跨性别成年人的全国数据，进行多水平分析，调查终身医疗拒绝。层次广义线性模型检验了个人（年龄、性别、种族、收入、保险和医疗回避）和州一级因素（投票给共和党的百分比、同性伴侣家庭的百分比、收入不平等和变性人保护法）与终身拒绝护理之间的关系。结果：结果显示，个体水平因素（年龄较大、跨性别、美洲原住民、多种族或其他种族/少数民族、收入低、因歧视而逃避护理）与拒绝护理呈正相关（p值均< 0.05）。调整个人层面的因素，在美国各州之间观察到差异，与美国其他地区相比，美国南部和西部的变性居民经历拒绝护理的几率更高。在调整州一级因素后，跨性别成年人中投票给共和党的州人口百分比与拒绝护理呈正相关（P < 0.01）。结论：接受调查的跨性别成年人报告了不同地理区域获得医疗保健的差异。确定与保健障碍相关的地理和个人因素，有助于制定有针对性的教育和政策干预措施，以改善最需要服务的变性人获得保健服务的机会。
Purpose: To identify geographic and individual-level factors associated with healthcare access among transgender people in the United States.Methods: Multilevel analyses were conducted to investigate lifetime healthcare refusal using national data from 5831 U.S. transgender adults. Hierarchical generalized linear models examined associations between individual (age, gender, race, income, insurance, and healthcare avoidance) and state-level factors (percent voting Republican, percent same-sex couple households, income inequality, and transgender protective laws) and lifetime refusal of care.Results: Results show that individual-level factors (being older; trans feminine; Native American, multiracial, or other racial/ethnic minority; having low income; and avoiding care due to discrimination) are positively associated with care refusal (all P-values < 0.05). Adjusting for individual-level factors, variation was observed across U.S. states, with a greater proportion of states in the Southern and Western United States with transgender residents at increased odds of experiencing care refusal, relative to other regions of the United States. When adjusting for state-level factors, the percentage of the state population voting Republican was positively associated with care refusal among the transgender adults sampled (P < 0.01).Conclusion: Transgender adults surveyed reported differential access to healthcare by geographic region. Identifying geographic and individual-level factors associated with healthcare barriers allows for the development of targeted educational and policy interventions to improve healthcare access for transgender people most in need of services.