Goldstein Deborah A, Sarkodie Eleanor, Hardy W David
Whitman-Walker Institute, Washington, District of Columbia.
Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia.
Transgend Health. 2019 Sep 23;4(1):200-208. doi: 10.1089/trgh.2019.0022. eCollection 2019.
Washington, DC, has the highest prevalence of transgender persons in the United States at 2.8%. Transgender persons in DC have lower income, less stable housing, and more HIV infection than nontrans persons. Data are scarce regarding primary care quality among trans persons. We provide a detailed analysis of transgender patients at Whitman-Walker Health, an HIV- and LGBT-focused community health center. We performed a retrospective electronic medical record review of transgender patients ≥18 years of age from 2008 to 2016, evaluating demographic factors, HIV status, gender-affirming care, and primary care quality indicators. Of 20,097 patients, 1822 (9.0%) self-identify as transgender (62.9% trans female and 37.2% trans male), and 18,275 were nontransgender. Transgender patients are more likely to be young, white, HIV negative, and reside outside Washington, DC, than nontrans patients. Transgender patients are more likely to engage in primary care and have a similar likelihood of mammogram and colonoscopy screening than nontrans patients. Trans males are more likely to be privately insured, have lower rates of HIV testing than nontrans patients, and have higher rates of cervical Pap smears than cis females. Trans females have a high prevalence of HIV infection (26.6%). This is the largest single-center U.S. transgender cohort to date. Over a quarter of trans females are HIV positive, consistent with a national prevalence of 27.7%. Transgender and nontrans patients do not receive statistically different quality of primary care. Trans patients' high engagement in primary care may result from providing hormone therapy and primary care within a single provider visit.
华盛顿特区的跨性别者在美国的患病率最高，为2.8%。与非跨性别者相比，华盛顿特区的跨性别者收入更低、住房更不稳定，感染艾滋病毒的比例更高。关于跨性别者初级保健质量的数据很少。我们对惠特曼-沃克健康中心的跨性别患者进行了详细分析，该中心是一家专注于艾滋病毒和 LGBT群体的社区健康中心。我们对2008年至2016年18岁及以上的跨性别患者进行了回顾性电子病历审查，评估了人口统计学因素、艾滋病毒状况、性别确认护理和初级保健质量指标。在20097名患者中，1822名（9.0%）自我认定为跨性别者（62.9%为跨性别女性，37.2%为跨性别男性），18275名是非跨性别者。与非跨性别患者相比，跨性别患者更可能年轻、是白人、艾滋病毒阴性，且居住在华盛顿特区以外。跨性别患者比非跨性别患者更有可能接受初级保健，进行乳房X光检查和结肠镜检查的可能性相似。跨性别男性更有可能拥有私人保险，艾滋病毒检测率低于非跨性别患者，宫颈涂片检查率高于顺性别女性。跨性别女性艾滋病毒感染率很高（26.6%）。这是迄今为止美国最大的单中心跨性别者队列。超过四分之一的跨性别女性艾滋病毒呈阳性，与全国27.7%的患病率一致。跨性别患者和非跨性别患者接受的初级保健质量在统计学上没有差异。跨性别患者对初级保健的高参与度可能是因为在一次就诊中就能获得激素治疗和初级保健。
