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

Introduction: Transgender and gender diverse populations account for more than 1.3 million adults in the United States 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 US states.

Methods: Data on adults aged 18 years and older were extracted from two 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 based on provider reimbursement claims between 2017-2019. This study used hierarchical Bayesian models that borrowed information across states, time, and covariate groups to improve precision.

Results: We identified five gender non-affirming states (Tennessee, Louisiana, Texas, Idaho, and Indiana) and five gender-affirming states (Illinois, California, Washington, Maryland, and New York). Results based on the BRFSS 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 non-affirming states than in gender-affirming states. Results based on Medicaid claims data were mixed.

Conclusions: State-level policy environments may affect disparities in preventive medicine for transgender individuals. Moving towards public policies and best clinical practices that are gender-affirming may improve health care access and advance health equity for transgender and gender diverse populations across the United States.