Frank John, Restar Arjee, Kuhns Lisa, Reisner Sari, Biello Katie, Garofalo Robert, Mimiaga Matthew J
Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, Rhode Island.
Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.
Transgend Health. 2019 Jan 17;4(1):1-8. doi: 10.1089/trgh.2018.0026. eCollection 2019.
The physical health care needs of transgender women are not being adequately addressed in the United States. The current study adds to the literature on the state of health care among young transgender women (YTW) by describing the occurrence of unmet health needs among a sample of YTW and providing unique data on psychosocial and demographic factors associated with access to adequate care. Baseline data were analyzed from Project LifeSkills, an intervention study funded by the National Institutes of Health (NIH). YTW (=300) between the ages of 16 and 29 were recruited from the Boston and Chicago metropolitan areas between 2012 and 2015. Data were collected on health care experiences, indicators of social marginalization, and sociodemographic information. The final analytic sample (=273) was restricted to participants with complete data; participants that were removed did not significantly differ demographically from the final analytic sample retained. Bivariate logistic regression models examined the association between having unmet health care needs and sociodemographics, social marginalization, and health care utilization indicators. A final adjusted multivariable logistic regression model was constructed with independent variables that were statistically significant in bivariate models. Overall, nearly a quarter (23%) of YTW indicated that they had unmet health care needs. In the final multivariable model adjusted for enrollment city, avoiding health care due to cost (adjusted odds ratio [aOR]=1.98, 95% confidence interval [CI]=1.05-3.76) and experiencing prior transgender-specific discrimination in a medical setting (aOR=4.54, 95% CI=2.30-8.95]) were associated with a greater odds of having unmet health care needs. YTW face significant barriers to accessing health care in the United States. Among this sample, prior experiences of discrimination and inability to afford health care increased YTW odds of having unmet health care needs. Efforts to improve the unmet health care needs among YTW should promote access to affordable, gender-affirming care.
美国跨性别女性的身体健康护理需求未得到充分满足。本研究通过描述年轻跨性别女性（YTW）样本中未满足的健康需求情况，并提供与获得充分护理相关的心理社会和人口统计学因素的独特数据，丰富了关于年轻跨性别女性医疗保健状况的文献。对“生活技能项目”的基线数据进行了分析，该项目是一项由美国国立卫生研究院（NIH）资助的干预研究。2012年至2015年期间，从波士顿和芝加哥大都市区招募了年龄在16至29岁之间的YTW（n = 300）。收集了关于医疗保健经历、社会边缘化指标和社会人口统计学信息的数据。最终分析样本（n = 273）仅限于拥有完整数据的参与者；被排除的参与者在人口统计学上与保留的最终分析样本没有显著差异。二元逻辑回归模型检验了未满足的医疗保健需求与社会人口统计学、社会边缘化和医疗保健利用指标之间的关联。构建了一个最终调整的多变量逻辑回归模型，其自变量在二元模型中具有统计学意义。总体而言，近四分之一（23%）的YTW表示她们有未满足的医疗保健需求。在最终的多变量模型中，调整了登记城市、因费用而避免医疗保健（调整后的优势比[aOR]=1.98，95%置信区间[CI]=1.05 - 3.76）以及在医疗环境中经历过先前特定于跨性别的歧视（aOR=4.54，95% CI=2.30 - 8.95）与有未满足的医疗保健需求的更高几率相关。在美国，YTW在获得医疗保健方面面临重大障碍。在这个样本中，先前的歧视经历和无力承担医疗保健费用增加了YTW有未满足的医疗保健需求的几率。改善YTW中未满足的医疗保健需求的努力应促进获得负担得起的、性别肯定的护理。
