More comorbidities, health service visits for transgender adults
Transgender individuals in Canada are more likely to have mental and physical health comorbidities and use health services more often than cisgender individuals, according to data published in JAMA Network Open.
“There is limited information on the health conditions that affect the transgender population and how transgender people are being served by the health care system,” Alex Abramovich, PhD, a scientist at the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health and assistant professor at the Dalla Lana School of Public Health at the University of Toronto, told Healio. “The majority of institutional settings, including hospitals and primary health care settings’ administrative data, routinely collect data on sex designation ... rather than gender identity. This perpetuates data and institutional erasure and makes it very difficult to identify transgender and nonbinary individuals and creates challenges for transgender and nonbinary individuals to navigate the health care system.”
Abramovich and colleagues conducted a cross-sectional study comparing data from 2,085 transgender adults (mean age, 30.4 years; 37% transgender women) with a random sample of the general population of Ontario, Canada, from 2012 to 2016. Data on the transgender individuals were obtained from four outpatient clinics that collect data on self-defined gender identity. Transgender people were identified through an electronic medical record search or manual record audit. The two groups were compared based on sociodemographic information, such as neighborhood-level income; medical comorbidities; and health service variables, such as physician visits; mental and nonmental health and psychiatrist visits; specialist visits; ED visits; and hospitalizations. Transgender and cisgender individuals were matched 1:5 based on age.
The transgender group had a higher proportion of people with clinical chronic comorbidities compared with the general population group (33.7% vs. 28.2%; P < .001). Comorbidities with a higher prevalence among transgender individuals vs. cisgender people included asthma (23.5% vs. 19.5%; P < .001), diabetes (5.5% vs. 3.4%; P < .001), chronic obstructive pulmonary disease (2.4% vs. 1.5%; P = .002) and HIV (1.6% vs. 0.1%; P < .001).
Transgender individuals had a higher mean number of mental health-related primary care physician visits (9.11 vs. 2.1), nonmental health-related physician visits (13.44 vs. 11.08), psychiatrist visits (8.25 vs. 0.93) and nonpsychiatric specialists visits compared with the general population. The transgender group also had a higher number of mean overall ED visits (4.66 vs. 1.88 for cisgender individuals). The number of mean mental health ED visits (1.22 vs. 0.11) and self-harm ED visits (0.13 vs. 0.01) were also higher in the transgender group. Transgender individuals also had more overall hospitalizations compared with the general population (0.77 vs. 0.23) and more visits for mental health-related reasons (0.53 vs. 0.03).
“Previous research has reported that transgender individuals avoid health services, our study shows transgender individuals use health services at much higher rates than the general population, particularly for mental health and self-harm, including psychiatrist visits,” Abramovich said. “The higher rates of health service use for mental health and self-harm-related reasons may reflect the health service manifestation of stigma and discrimination.”
Transgender individuals were more likely to live in one of the two lowest neighborhood income quintiles when compared with the general population (30% vs. 21.1%; P < .001). More than half of transgender individuals in the study were enrolled under the public provincial drug plan, whereas less than one-quarter of the general population was enrolled (52.9% vs. 23.3%; P < .001).
Abramovich said the findings reveal the importance for providers to identify transgender individuals in health data and to be aware of the population’s increased risk for mental health issues and self-harm.
“Primary care practitioners can provide proper care to transgender people by committing to this work, including a gender identity question on key forms, seeking transgender inclusion training and collaborating with an interdisciplinary team,” Abramovich said.
For more information:
Alex Abramovich, PhD, can be reached at Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON M5S 2S1, Canada; email: alex.abramovich@camh.ca
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