Marano Andrew A, Miller Amitai S, Castillo Wendy, Reisner Sari L, Schechter Loren S, Coon Devin
Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
LGBT Health. 2024 Nov-Dec;11(8):615-624. doi: 10.1089/lgbt.2023.0341. Epub 2024 Jun 7.
Transgender and gender-diverse (TGD) individuals in the United States face disproportionate barriers to health care access. This study compared characteristics of individuals who have and have not undergone gender-affirming surgery with the goal of identifying social and systemic barriers to transition-related surgery. Data were extracted from the 2015 United States Transgender Survey, a cross-sectional nonprobability sample of nearly 28,000 TGD adults. The primary outcome was having undergone gender-affirming surgery. Multivariable logistic regression models were constructed to determine correlates of receipt of gender-affirming surgery. A subgroup analysis was performed to explore differences by insurance types regarding coverage of surgical procedures and presence of in-network providers. In total, 6009 (21.7%) participants underwent transition-related procedures. Increased odds of undergoing surgery were associated with older age, living in congruent gender, higher education attainment, and greater income. Decreased odds were linked with male sex assignment at birth, first recognizing TGD status at older ages, living in states without trans-protective health laws, no close transgender-knowledgeable health care provider, nonbinary status, and identifying as sexual minority. Residing in states without trans-protective health laws correlated with increased surgery denials over the previous 12-month period. Compared to White TGD individuals, TGD individuals who were Black, Latinx, or Another Race were significantly more likely to encounter health equity-related barriers to surgery. Gender-affirming surgery access is differentially distributed across demographic and modifiable equity-related factors amenable to interventions. Efforts are needed to address the number and geographic distribution of transgender health-competent providers, improve TGD legal protections, and increase access to health insurance for minority TGD individuals, who are disproportionately under/uninsured.
美国的跨性别者和性别多元者（TGD）在获得医疗保健方面面临着不成比例的障碍。本研究比较了接受和未接受性别确认手术的个体特征，目的是确定与过渡相关手术的社会和系统性障碍。数据取自2015年美国跨性别者调查，这是一个对近28000名TGD成年人的横断面非概率样本。主要结果是是否接受了性别确认手术。构建多变量逻辑回归模型以确定接受性别确认手术的相关因素。进行了亚组分析，以探讨不同保险类型在手术程序覆盖范围和网络内提供者存在方面的差异。共有6009名（21.7%）参与者接受了与过渡相关的手术。接受手术的几率增加与年龄较大、以符合自身性别的身份生活、受教育程度较高和收入较高有关。几率降低与出生时被指定为男性、在较大年龄首次认识到自己的TGD身份、生活在没有跨性别保护健康法的州、没有亲近的了解跨性别者的医疗保健提供者、非二元性别身份以及被认定为性少数群体有关。生活在没有跨性别保护健康法的州与在过去12个月内手术被拒的几率增加相关。与白人TGD个体相比，黑人、拉丁裔或其他种族的TGD个体在手术中更有可能遇到与健康公平相关的障碍。性别确认手术的可及性在不同人口统计学和可干预的公平相关因素中分布不均。需要努力解决有能力提供跨性别健康服务的提供者的数量和地理分布问题，改善对TGD的法律保护，并增加少数族裔TGD个体获得医疗保险的机会，这些个体未参保或参保比例过高。
