Article Figures & Data
Tables
- Table 1.
Weighted Frequency and Prevalence Estimates of Negative Healthcare Experiences, Mental Health and Substance Abuse Outcomes and Covariatesa
Variable, weighted n (%) Overall (weighted n = 18,890) Age 18–24 2368 (12.5) 25–44 7731 (40.9) 45–64 6513 (34.5) ≥65 2278 (12.1) Race/ethnicity Other 1137 (6.0) Black/African American 2466 (13.1) Latinx/Hispanic 2721 (14.4) White 12,565 (66.5) Education level <High school 2360 (12.5) High school grad/GED 4810 (25.5) Some college/associate degree 6144 (32.5) Bachelor’s degree or higher 5576 (29.5) Gender identity Transgender woman 10,572 (56.0) Transgender man 4749 (25.1) Nonbinary/genderqueer (birth assigned female) 2545 (13.5) Nonbinary/genderqueer (birth assigned male) 1024 (5.4) Sexual orientation Asexual 1529 (8.1) LGB+ 11,951 (63.3) Heterosexual 4352 (23.0) Other/not listed 1058 (5.6) Family support of gender identity Supportive 9206 (48.7) Neutral 3074 (16.3) Unsupportive 2856 (15.1) No immediate family or none know I am trans 3754 (19.9) Current healthcare clinicians know I am trans No people like this in my life 887 (4.7) All know 10,269 (54.4) Most know 2393 (12.7) Some know 2433 (12.9) None know 2908 (15.4) Gender identity change efforts (GICE) 3057 (16.2) Sexual identity change efforts (SICE) 1836 (9.7) Healthcare experiences in the last year (yes) Positive experience Doctor knew trans and treated with respect 13,886 (73.5) Negative experiences Had to teach doctor about trans careb 4678 (24.8) Doctor refused to give trans-related careb 1675 (8.9) Doctor refused to give other healthcareb 783 (4.1) Doctor asked invasive questions about trans statusb 2444 (12.9) Doctor used harsh/abusive language 1009 (5.3) Doctor was physically rough/abusive 440 (2.3) Verbally harassed in a healthcare setting 1407 (7.4) Physically attacked in a healthcare setting 250 (1.3) Unwanted sexual contact in a healthcare setting 371 (2.0) Any negative experience 6609 (35.0) No. of negative experiences (range, 0–9) Mean (±SE) = 0.69 (±0.03) No. of negative experiences (categories) None 12,281 (65.0) One 3558 (18.8) Two 1497 (7.9) Three or more 1555 (8.2) Outcomes Binge alcohol usec 4315 (22.8) Heavy alcohol usec 1358 (7.2) Smokingc 4258 (22.5) Marijuana usec 4505 (23.8) Other illicit drug usec 1563 (8.3) Severe psychological distressc,d 5628 (29.8) Suicidal ideatione 7611 (40.3) Suicide attempte 1161 (6.1) Abbreviations: SE, standard error; GED, General Equivalency Diploma; LGB+, lesbian, gay, bisexual and transgender/transsexual people. aWeighted frequency and prevalence estimates of negative healthcare experiences, mental health and substance abuse outcomes, and covariates for nonbinary/genderqueer and transgender participants who had seen a healthcare clinician in the last year. There were 21,740 participants eligible for analysis. The total weighted frequency representing eligible participants used as the denominator in complex survey analysis is 18,890 and numbers in table represent weighted frequency and prevalence estimates. Per the 2015 US Transgender Survey: n = 21,740 (unweighted frequency) participants eligible for analysis).
bForm of subtle discrimination.
cIn the last month.
dKessler Psychological Distress Scale score ≥13.
eIn the last year.
- Table 2.
Weighted Frequency and Prevalence Estimates of Healthcare Experiences in the Last Year by Mental Health Outcomesa
Severe psychological distress Suicide ideation Suicide attempt No Yes No Yes No Yes Variable, weighted n (%) (n = 13262) (n = 5628) P (n = 11278) (n = 7611) P (n = 17729) (n = 1161) P Healthcare experiences in the last year (yes) Doctor knew trans and treated with respect 10,357 (78.1) 3529 (62.7) <.0001 8666 (76.8) 5220 (68.6) <.0001 13,073 (73.7) 818 (70.0) .225 Had to teach doctor about trans care 3023 (22.8) 1655 (29.4) .0002 2494 (22.1) 2184 (28.7) .0001 4293 (24.2) 385 (33.2) .004 Doctor refused to give trans-related care 851 (6.4) 824 (14.6) <.0001 629 (5.6) 1046 (13.7) <.0001 1465 (8.3) 210 (18.1) <.0001 Doctor refused to give other healthcare 446 (3.4) 337 (6.0) .008 333 (3.0) 449 (5.9) .004 694 (3.9) 88 (7.6) .001 Doctor asked invasive questions about trans status 1405 (10.6) 1038 (18.5) <.0001 1087 (9.6) 1357 (17.8) <.0001 2173 (12.3) 271 (23.6) <.0001 Doctor used harsh/abusive language 523 (3.9) 486 (8.6) <.0001 418 (3.7) 591 (7.8) .0004 861 (4.9) 148 (12.7) <.0001 Doctor was physically rough/abusive 189 (1.4) 251 (4.4) <.0001 174 (1.5) 266 (3.5) .004 376 (2.1) 64 (5.5) .051 Verbally harassed in a healthcare setting 679 (5.1) 728 (12.9) <.0001 555 (4.9) 852 (11.2) .0001 1199 (6.8) 207 (17.8) <.0001 Physically attacked in a healthcare setting 116 (0.9) 134 (2.4) .110 145 (1.3) 106 (1.4) .891 194 (1.1) 56 (4.8) .017 Unwanted sexual contact in a healthcare setting 201 (1.5) 170 (3.0) .167 191 (1.7) 180 (2.4) .514 288 (1.6) 83 (7.1) .002 aValues represent weighted frequencies derived from complex survey analyses.
- Table 3.
Weighted Frequency and Prevalence Estimates of Healthcare Experiences in the Last Year by Smoking and Drinking Outcomesa
Binge drinking Heavy alcohol Smoking No Yes No Yes No Yes Variable, weighted n (%) (n = 14574) (n = 4315) P (n = 17532) (n = 1358) P (n = 14632) (n = 4258) P Healthcare experiences in the last year (yes) Doctor knew trans and treated with respect 10,782 (74.0) 3104 (71.9) .234 12,931 (73.8) 955 (70.3) .242 10,698 (73.1) 3188 (74.9) .354 Had to teach doctor about trans care 3619 (24.8) 1060 (24.6) .875 4296 (24.5) 383 (28.2) .207 3546 (24.2) 1132 (26.6) .249 Doctor refused to give trans-related care 1250 (8.6) 425 (9.8) .326 1510 (8.6) 165 (12.2) .139 1243 (8.5) 432 (10.1) .151 Doctor refused to give other healthcare 628 (4.3) 155 (3.6) .460 744 (4.2) 39 (2.9) .230 566 (3.9) 217 (5.1) .269 Doctor asked invasive questions about trans status 1763 (12.1) 681 (15.8) .013 2184 (12.5) 260 (19.1) .006 1782 (12.2) 662 (15.6) .025 Doctor used harsh/abusive language 733 (5.0) 276 (6.4) .219 898 (5.1) 111 (8.2) .161 631 (4.3) 378 (8.9) .001 Doctor was physically rough/abusive 300 (2.1) 1340 (3.2) .179 375 (2.1) 65 (4.8) .122 336 (2.3) 104 (2.4) .842 Verbally harassed in a healthcare setting 964 (6.6) 443 (10.3) .040 1278 (7.3) 129 (9.5) .358 1011 (6.9) 396 (9.3) .175 Physically attacked in a healthcare setting 181 (1.2) 69 (1.6) .692 206 (1.2) 45 (3.3) .177 123 (0.8) 128 (3.0) .028 Unwanted sexual contact in a healthcare setting 288 (2.0) 84 (1.9) .972 320 (1.8) 51 (3.8) .278 294 (2.0) 77 (1.8) .816 aValues represent weighted frequencies derived from complex survey analyses.
- Table 4.
Weighted Frequency and Prevalence Estimates of Healthcare Experiences in the Last Year by Illicit Drug Usea
Marijuana use Other illicit drug use No Yes No Yes Variable, weighted n (%) (n = 14385) (n = 4505) P (n = 17327) (n = 1563) P Healthcare experiences in the last year (yes) Doctor knew trans and treated with respect 10,347 (71.9) 3539 (78.6) <.0001 12,826 (74.0) 1060 (67.8) .023 Had to teach doctor about trans care 3411 (23.7) 1268 (28.1) .019 4227 (24.4) 451 (28.8) .091 Doctor refused to give trans-related care 1157 (8.0) 518 (11.5) .009 1446 (8.3) 229 (14.7) .003 Doctor refused to give other healthcare 542 (3.8) 241 (5.3) .113 675 (3.9) 107 (6.9) .044 Doctor asked invasive questions about trans status 1656 (11.5) 787 (17.5) <.0001 2129 (12.3) 314 (20.1) .001 Doctor used harsh/abusive language 611 (4.2) 398 (8.8) <.0001 829 (4.8) 180 (11.5) .0003 Doctor was physically rough/abusive 240 (1.7) 20 (4.4) .001 337 (1.9) 103 (6.6) .002 Verbally harassed in a healthcare setting 885 (6.2) 521 (11.6) .002 1189 (6.9) 218 (13.9) .001 Physically attacked in a healthcare setting 156 (1.1) 94 (2.1) .275 171 (1.0) 79 (5.1) .004 Unwanted sexual contact in a healthcare setting 253 (1.8) 119 (2.6) .411 288 (1.7) 84 (5.3) .029 aNumbers in headings and table represent weighted frequencies from complex survey analyses.
- Table 5.
Weighted Adjusted Odds Ratios (AORs) and 95% Confidence Intervals (CIs) for the Relationship of Last Year Healthcare Experiences With Mental Health and Substance Use Outcomesa
Severe psychological distress Suicide ideation Suicide attempt Binge drinking Heavy alcohol Smoking Marijuana use Other illicit drug use AOR AOR AOR AOR AOR AOR AOR AOR Variable 95% CI 95% CI 95% CI 95% CI 95% CI 95% CI 95% CI 95% CI Healthcare experiences in the last year (yes) Doctor knew trans and treated with respect 0.74 0.88 0.71 0.92 0.80 0.85 1.50 0.79 0.58, 0.95 0.72, 1.10 0.45, 1.12 0.68, 1.23 0.46, 1.39 0.61, 1.19 1.14, 1.97 0.52, 1.22 Had to teach doctor about trans care 1.56 1.42 1.43 0.97 1.23 1.05 1.11 1.19 1.28, 1.91 1.19, 1.71 1.06, 1.91 0.81, 1.16 0.94, 1.61 0.87, 1.28 0.92, 1.33 0.94, 1.51 Doctor refused to give trans-related care 2.33 2.35 1.73 1.10 1.33 1.01 1.22 1.62 1.73, 3.13 1.79, 3.07 1.22, 2.45 0.82, 1.48 0.86, 2.05 0.76, 1.35 0.92, 1.62 1.15, 2.28 Doctor refused to give other healthcare 1.71 1.95 1.59 0.82 0.61 1.20 1.35 1.63 1.08, 2.71 1.15, 3.32 0.97, 2.62 0.49, 1.38 0.30, 1.25 0.72, 2.00 0.88, 2.07 0.99, 2.66 Doctor asked invasive questions about trans status 1.59 1.64 1.62 1.23 1.58 1.18 1.30 1.48 1.24, 2.04 1.30, 2.07 1.18, 2.24 0.98, 1.55 1.16, 2.15 0.91, 1.53 1.04, 1.64 1.13, 1.92 Doctor used harsh/abusive language 1.63 1.56 1.87 1.15 1.46 1.86 1.73 2.02 1.07, 2.49 1.01, 2.42 1.18, 2.95 0.78, 1.70 0.81, 2.63 1.23, 2.81 1.17, 2.55 1.31, 3.12 Doctor was physically rough/abusive 2.77 1.88 1.75 1.44 1.95 0.93 2.35 2.92 1.59, 4.81 1.02, 3.48 0.82, 3.75 0.74, 2.79 0.79, 4.82 0.49, 1.76 1.32, 4.20 1.48, 5.75 Verbally harassed in a healthcare setting 2.69 2.22 2.26 1.70 1.28 1.15 1.60 2.02 1.56, 4.62 1.31, 3.76 1.51, 3.39 1.10, 2.61 0.79, 2.07 0.76, 1.74 1.05, 2.44 1.39, 2.93 Physically attacked in a healthcare setting 1.60 0.54 2.00 1.11 2.54 2.69 1.27 4.48 0.39, 6.52 0.16, 1.82 0.64, 6.29 0.33, 3.72 0.67, 9.64 0.83, 8.76 0.42, 3.80 1.50, 13.34 Unwanted sexual contact in a healthcare setting 1.73 1.17 3.43 0.99 1.96 0.71 1.26 3.37 0.75, 3.96 0.50, 2.75 1.62, 7.29 0.41, 2.40 0.65, 5.89 0.31, 1.68 0.59, 2.72 1.51, 7.54 Abbreviations: AOR, adjusted odds ratio; CI, confidence interval.
aSeparate model for each question and outcome pair. Each model adjusted for age, race, education, family support of gender identity, gender identity, sexual orientation, gender and sexual identity change efforts, current healthcare clinicians know participant is trans.
