Disparities in Preventive Health Services Between Transgender and Cisgender Adults by State-Level Policy Environments

Area of Science:

• Public Health
• Health Policy
• Health Equity

Background:

• Transgender and gender-diverse individuals (1.3 million adults in the U.S.) face significant health disparities and barriers to care.
• State-level policies create varied environments affecting healthcare access for these populations.

Purpose of the Study:

• To compare preventive health services utilization between transgender and cisgender adults across different state policy environments.
• To analyze the impact of gender-affirming versus gender-nonaffirming state policies on healthcare disparities.

Main Methods:

• Utilized data from the 2017-2019 Behavioral Risk Factor Surveillance System (BRFSS) and Medicaid claims data.
• Included self-identified transgender (n=748) and cisgender (n=204,973) adults from BRFSS, and transgender (n=38,037) and cisgender (n=34,645,129) adults from Medicaid claims.
• Employed hierarchical Bayesian models for improved precision by borrowing information across states, time, and covariates.

Main Results:

• Identified 5 gender-nonaffirming and 5 gender-affirming states.
• BRFSS data showed wider disparities in annual wellness visits, primary care access, flu vaccination, and screenings (HIV, diabetes, cervical cancer) for transgender adults in non-affirming states.
• Medicaid claims data yielded mixed results regarding disparities.

Conclusions:

• State-level policy environments significantly influence disparities in preventive care for transgender individuals.
• Adopting gender-affirming public policies and clinical practices can enhance healthcare access and advance health equity for transgender and gender-diverse populations.