Center for Applied Transgender Studies, Chicago, IL, USA; School of Information, University of Michigan, Ann Arbor, MI, USA; Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Keck School of Medicine, Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA.
Spat Spatiotemporal Epidemiol. 2023 Jun;45:100585. doi: 10.1016/j.sste.2023.100585. Epub 2023 Apr 8.
While the extant literature has established that transgender people face significant barriers to accessing healthcare, no studies to date have offered an explicitly spatial analysis of their access to trans-specific care. This study aims to fill that gap by providing a spatial analysis of access to gender-affirming hormone therapy (GAHT) using Texas as a case study. We used the three-step floating catchment area method, which relies on census tract-level population data and location data for healthcare facilities to quantify spatial access to healthcare within a specific drive-time window, in our case 120 min. For our tract-level population estimates we adapt estimates of the rates of transgender identification from a recent data source, the Household Pulse Survey, and use these in tandem with a spatial database of GAHT providers of the lead author's creation. We then compare results of the 3SFCA with data on urbanicity and rurality, as well as which areas are deemed medically underserved. Finally, we conduct a hot-spot analysis that identifies specific areas where health services could be planned in ways that could improve both access to GAHT for trans people and access to primary care for the general population. Ultimately, we conclude that our results illustrate that patterns of access to trans-specific medical care, like GAHT, do not neatly follow patterns of access to primary care for the general population and that therefore trans communities' access to healthcare warrants specific, further investigation.
虽然现有文献已经证实跨性别者在获得医疗保健方面面临重大障碍，但迄今为止，没有研究对他们获得特定于跨性别者的护理进行明确的空间分析。本研究旨在通过使用德克萨斯州作为案例研究，对获得性别肯定激素治疗（GAHT）的机会进行空间分析来填补这一空白。我们使用了三步浮动集水区方法，该方法依赖于人口普查区层面的人口数据和医疗设施的位置数据，以在特定的驾驶时间窗口内量化医疗保健的空间可达性，在我们的案例中是 120 分钟。对于我们的区层面人口估计，我们适应了最近来源——家庭脉搏调查中跨性别认同率的估计，并将这些与作者创建的 GAHT 提供者的空间数据库结合使用。然后，我们将 3SFCA 的结果与城市和农村程度的数据以及哪些地区被认为医疗服务不足进行比较。最后，我们进行热点分析，确定可以以改善跨性别者获得 GAHT 和普通人群获得初级保健的方式规划卫生服务的特定区域。最终，我们的结论是，我们的结果表明，获得特定于跨性别者的医疗保健的模式，如 GAHT，与普通人群获得初级保健的模式并不完全一致，因此跨性别者群体获得医疗保健需要进行具体、进一步的调查。
