University of Minnesota, Saint Paul, USA.
University of Minnesota, Minneapolis, USA.
Med Care Res Rev. 2024 Feb;81(1):68-77. doi: 10.1177/10775587231191649. Epub 2023 Aug 7.
The objective of this study is to examine access to care based on gender identity in urban and rural areas, focusing on transgender and gender diverse (TGD) populations. Data on TGD ( = 1,678) and cisgender adults ( = 403,414) from the 2019 to 2020 Behavioral Risk Factor Surveillance System were used. Outcome measures were four barriers to care. We conducted bivariate and multivariable logistic regressions to assess associations between access, rurality, and gender identity. Bivariate results show that TGD adults were significantly more likely to experience three barriers to care. In multivariable models, TGD adults were more likely to delay care due to cost in the full sample (adjusted odds ratio [AOR]: 2.00, < .001), rural subsample (AOR: 2.14, < .01), and urban subsample (AOR: 1.97, < .01). This study revealed greater barriers to care for TGD adults, with the most frequent barriers found among rural TGD adults. Increased provider awareness and structural policy changes are needed to achieve health equity for rural TGD populations.
本研究旨在考察城乡地区基于性别认同的获得医疗服务的情况，重点关注跨性别和性别多样化（TGD）人群。该研究使用了来自 2019 年至 2020 年行为风险因素监测系统的 TGD（n=1678）和顺性别成年人（n=403414）的数据。结果测量指标为四项获得医疗服务的障碍。我们进行了单变量和多变量逻辑回归分析，以评估获得医疗服务的情况、城乡差异和性别认同之间的关联。单变量结果表明，TGD 成年人更有可能经历三种获得医疗服务的障碍。在多变量模型中，TGD 成年人更有可能因为费用而延迟医疗服务，在全样本中（调整后的优势比 [AOR]：2.00， <.001）、农村亚样本中（AOR：2.14， <.01）和城市亚样本中（AOR：1.97， <.01）。本研究揭示了 TGD 成年人面临更大的获得医疗服务的障碍，农村 TGD 成年人中最常见的障碍。需要提高提供者的认识和进行结构性政策改革，以实现农村 TGD 人群的健康公平。
