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Review
. 2022 Aug 1;7(4):292-302.
doi: 10.1089/trgh.2020.0182. eCollection 2022 Aug.

Health Insurance Prevalence Among Gender Minority People: A Systematic Review and Meta-Analysis

Kristen D Clark  1 , Athena D F Sherman  2 , Annesa Flentje  1   3
Affiliations
Review

Health Insurance Prevalence Among Gender Minority People: A Systematic Review and Meta-Analysis

Kristen D Clark et al. Transgend Health. .

Abstract

Purpose: Gender minority (GM) (people whose gender does not align with the sex assigned at birth) people have historically been insured at lower rates than the general population. The purpose of this review is to (1) assess the prevalence of health insurance among GM adults in the United States, (2) examine prevalence by gender, and (3) examine trends in prevalence before and after implementation of the Affordable Care Act.

Methods: Published articles from PubMed, EMBASE, and Web of Science databases before April 26th, 2019, were included. This review is registered on PROSPERO (CRD42019133627). Analysis was guided by a random-effects model to obtain a meta-prevalence estimate for all GM people and stratified by gender subgroup. Heterogeneity was assessed using a Q-test and I 2 measure.

Results: Of 55 included articles, a random pooled estimate showed that 75% GM people were insured (95% confidence interval [CI]: 0.71-0.79; p<0.001). Subgroup analysis by gender determined 70% of transgender women (95% CI: 0.64-0.76; p<0.001; I 2=97.16%) and 80% of transgender men (95% CI: 0.77-0.83; p=0.01; I 2=54.51%) were insured. Too few studies provided health insurance prevalence data for gender-expansive participants (GM people who do not identify as solely man or woman) to conduct analysis.

Conclusion: The pooled prevalence of health insurance among GM people found in this review is considerably lower than the general population. Standardized collection of gender across research and health care will improve identification of vulnerable individuals who experience this barrier to preventative and acute care services.

Keywords: delivery of health care; health; health disparities; insurance; sexual and gender minorities.

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Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
PRISMA flow diagram for the searching and screening process. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
See this image and copyright information in PMC

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