Abstract

Background

Gender minorities and cisgender women face barriers to healthcare access. Prior work suggests cost may represent a particular barrier to accessing care for transgender and gender diverse (TGD) individuals.

Objective

To examine odds of delaying care for any reason and, secondarily, for 7 specific reasons among TGD individuals and cisgender women compared with cisgender men in the All of Us Research Program.

Design

We calculated the odds of delayed care by gender identity relative to cisgender men using multivariable-adjusted logistic regression, with adjustment for age, race, income, education, and Charlson comorbidity index.

Participants

We examined 117,806 All of Us participants who completed the healthcare access and utilization survey.

Main Measures

The primary outcome was self-reported delayed care in the past 12 months for any of 7 potential reasons: cost (out-of-pocket cost, co-payment costs, and/or high deductible), lack of childcare, lack of eldercare, nervousness associated with visiting the healthcare provider, rurality, inability to take time off work, and lack of transportation.

Key Results

Compared with cisgender men, the multivariable-adjusted odds ratio (OR) for delaying care for any reason was 1.48 (95% CI, 1.44–1.53; P < 0.001) among cisgender women, 1.65 (95% CI, 1.24–2.21; P < 0.001) among TGD individuals assigned male at birth, and 2.76 (95% CI, 2.26–3.39; P < 0.001) among TGD individuals assigned female at birth. Results were consistent across multiple sensitivity analyses. TGD individuals were substantially more likely to cite nervousness with visiting a healthcare provider as a barrier, whereas cisgender women were more likely to delay care due to lack of childcare coverage.

Conclusions

Cisgender women and TGD individuals were more likely to delay seeking heath care compared with cisgender men, and for partially different reasons. These findings highlight the need to address common and distinct barriers to care access among marginalized groups.

Topic

JGIM

Author Descriptions

Cardiovascular Research Center, Massachusetts General Hospital, 185 Cambridge St. CPZN 3.187, Boston, MA, 02114, USA
Phoebe Finneran BS, Pradeep Natarajan MD, MMSc & Michael C. Honigberg MD, MPP

Metabolism Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
Mabel P. Toribio MD

Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
Pradeep Natarajan MD, MMSc & Michael C. Honigberg MD, MPP

Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
Pradeep Natarajan MD, MMSc & Michael C. Honigberg MD, MPP

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