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

Transgender and gender-diverse populations account for more than 1.3 million adults in the U.S. and experience substantial health disparities and barriers to care. This study compared preventive health services utilization between transgender and cisgender adults by state-level policy environments in 10 U.S. states.

Data on adults aged ≥18 years were extracted from 2 different sources: self-identified transgender (n=748) and cisgender (n=204,973) adults from the 2017-2019 Behavioral Risk Factor Surveillance System as well as adults receiving a gender identity disorder diagnosis (i.e., transgender; n=38,037) or not receiving a gender identity disorder diagnosis (i.e., cisgender; n=34,645,129) in Medicaid on the basis of provider reimbursement claims between 2017 and 2019. This study used hierarchical Bayesian models that borrowed information across states, time, and covariate groups to improve precision.

The authors identified 5 gender-nonaffirming states (Tennessee, Louisiana, Texas, Idaho, and Indiana) and 5 gender-affirming states (Illinois, California, Washington, Maryland, and New York). Results based on the Behavioral Risk Factor Surveillance System indicated that the disparities between transgender and cisgender adults in receiving an annual wellness visit; having a primary care provider; and receiving a flu vaccine or screenings for HIV, diabetes, and cervical cancer were wider in gender-nonaffirming states than in gender-affirming states. Results based on Medicaid claims data were mixed.

State-level policy environments may affect disparities in preventive medicine for transgender individuals. Moving toward public policies and best clinical practices that are gender affirming may improve healthcare access and advance health equity for transgender and gender-diverse populations across the U.S.