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. 2022;19(4):1717-1730.
doi: 10.1007/s13178-022-00748-1. Epub 2022 Jul 15.

Healthcare Mistreatment, State-Level Policy Protections, and Healthcare Avoidance Among Gender Minority People

Kristen D Clark  1 , Sean Luong  2 , Mitchell R Lunn  3   4   5 , Elena Flowers  6 , Esmaeil Bahalkeh  7 , Micah E Lubensky  2   3 , Matthew R Capriotti  8 , Juno Obedin-Maliver  3   5   9 , Annesa Flentje  2   3   10
Affiliations

Healthcare Mistreatment, State-Level Policy Protections, and Healthcare Avoidance Among Gender Minority People

Kristen D Clark et al. Sex Res Social Policy. 2022.

Abstract

Introduction: This study examined whether past experiences of mistreatment in healthcare were associated with greater healthcare avoidance due to anticipated mistreatment among gender minority (GM) people. We evaluated whether state-level healthcare policy protections moderated this relationship.

Methods: Data from the 2018 Annual Questionnaire of The PRIDE Study, a national longitudinal study on sexual and gender minority people's health, were used in these analyses. Logistic regression modeling tested relationships between lifetime healthcare mistreatment due to gender identity or expression and past-year healthcare avoidance due to anticipated mistreatment among GM participants. Interactions between lifetime healthcare mistreatment and state-level healthcare policy protections and their relationship with past-year healthcare avoidance were tested.

Results: Participants reporting any lifetime healthcare mistreatment had greater odds of past-year healthcare avoidance due to anticipated mistreatment among gender expansive people (n = 1290, OR = 4.71 [CI]: 3.57-6.20), transfeminine people (n = 263, OR = 10.32 [CI]: 4.72-22.59), and transmasculine people (n = 471, OR = 3.90 [CI]: 2.50-6.13). Presence of state-level healthcare policy protections did not moderate this relationship in any study groups.

Conclusions: For GM people, reporting lifetime healthcare mistreatment was associated with healthcare avoidance due to anticipated mistreatment. State-level healthcare policy protections were not a moderating factor in this relationship. Efforts to evaluate the implementation and enforcement of state-level policies are needed. Continued efforts to understand instances of and to diminish healthcare mistreatment of GM people are recommended.

Supplementary information: The online version contains supplementary material available at 10.1007/s13178-022-00748-1.

Keywords: Gender minority; Health policy; Healthcare access; LGBTQ; Social determinants of health.

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Conflict of interest statement

Conflict of InterestMRL has consulted for Hims Inc. (2019–present) and Folx Inc (2020). JOM has consulted for Sage Therapeutics (5/2017) on a 1-day advisory board, Ibis Reproductive Health (a not-for-profit research group 3/2017–5/2018), Folx Inc. (2020–present), and Hims Inc. (2019–present). None of these roles present a conflict of interest with this work as described here. No other authors have conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
A dendrogram of the state cluster results
Fig. 2
Fig. 2
A map of the USA color coded by the 4 clusters and identification of states with Medicaid expansion (*)
Fig. 3
Fig. 3
Visualization of odds ratios with confidence intervals
See this image and copyright information in PMC

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