Gender Identity, Disability, and Unmet Healthcare Needs among Disabled People Living in the Community in the United States
Abstract
:1. Introduction
- Which disabilities are most common among transgender people with disabilities?
- Do the rates of types of disabilities differ between transgender people with disabilities and cisgender people with disabilities?
- Are there differences in unmet healthcare needs based on gender identity among disabled people?
1.1. Transgender, Non-Binary, and Gender Non-Conforming Identities and Definitions
1.2. Positionality Statement
2. Materials and Methods
2.1. Study Design
2.2. Setting and Data
2.3. Participants, Recruitment, and Privacy Protections
2.4. Measurement
2.4.1. Main Disability
2.4.2. Gender Identity
2.4.3. Unmet Healthcare Needs
2.4.4. Sociodemographic Characteristics
2.5. Statistical Analyses
3. Results
3.1. Narrative Summary of Results
3.2. Study Participants Demographics
3.3. Disability and Unmet Healthcare Needs across All Gender Identities
3.4. Comparisons of Rates of Disability Types by Unmet Needs and Gender
3.5. Rates and Odds of Unmet Healthcare Needs by Gender
4. Discussion
4.1. Prevalence and Importance of Disability Type among Disabled Transgender Participants
4.2. Unmet Healthcare Needs among Disabled Transgender Participants
4.2.1. Unable to See a Doctor as Needed
4.2.2. Unable to Get All the Dental Services Needed
4.2.3. Unable to Get Prescription Medication as Needed
4.2.4. Unable to See a Specialist as Needed
4.3. Limitations
4.4. Implications
4.5. Future Research
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Demographics | %(n) or Median (IQR) |
---|---|
Age | 40 (31, 53) |
Gender | |
Cisgender | 97.01% (2110) |
Transgender | 2.99% (65) |
Race/ethnicity * | |
American Indian or Native American | 1.15% (25) |
Hispanic/Latino | 2.99% (65) |
Black | 4.47% (103) |
Asian | 2.21% (48) |
Native Hawaiian or Pacific Islander | 0.18% (4) |
White | 78.9% (1716) |
Prefer not to answer | 2.21% (48) |
Level of Education | |
No formal education | 0.09% (2) |
Less than high school | 1.47% (31) |
High school diploma | 11.68% (254) |
Some college | 26.13% (568) |
Two-year college | 11.82% (257) |
Four-year college | 26.54% (577) |
Graduate/Doctoral | 21.43% (465) |
Prefer not to answer | 0.97% (21) |
Income | |
Under 138% FPL | 37.00% (794) |
138–249% FPL | 22.55% (484) |
250–399% FPL | 18.59% (399) |
400% FPL and above | 21.85% (469) |
Main Disability | |
Mental illness or psychiatric disability | 26.30% (572) |
Chronic illness or disease | 24.18% (526) |
Physical disability | 27.08% (589) |
Neurological condition | 10.80% (235) |
Sensory disability | 4.28% (93) |
Intellectual or cognitive disability | 2.90% (63) |
Developmental | 3.95% (86) |
Has insurance | 87.91% (1912) |
Unmet need with health insurance + | |
Unable to see doctor as needed | 12.72% (242) |
Unable to get prescription medication as needed | 17.14% (326) |
Unable to see a specialist as needed | 12.36% (235) |
Unable to get all the dental services needed | 29.50% (561) |
Unable to get all the preventative services needed | 10.62% (202) |
Reported one unmet need | 44.24% (903) |
Reported multiple unmet needs | 12.72% (242) |
Disability by Gender, % (n) | Prevalence of Disability Type by Gender in Those with at Least One Unmet Need +, % (n) | |||||
---|---|---|---|---|---|---|
Disability | Transgender (n = 65) | Cisgender (n = 2110) | Chi2 | Transgender (n = 38) | Cisgender(n = 865) | Chi2 |
Mental illness or psychiatric | 27.69% (18) | 26.26% (554) | 0.796 | 23.68%(9) | 24.39%(211) | 0.921 |
Chronic illness or disease | 27.69% (18) | 24.08% (508) | 0.502 | 26.32%(10) | 26.71%(231) | 0.958 |
Physical | 12.31% (8) | 27.54% (581) ** | 0.007 | 10.53%(4) | 27.40%(237) * | 0.021 |
Neurological condition | 10.77% (7) | 10.81% (228) | 0.993 | 13.16%(5) | 11.33%(98) | 0.729 |
Sensory disability | 4.62% (3) | 4.27% (90) | 0.891 | 7.89%(3) | 3.47%(30) | 0.155 |
Intellectual or cognitive | 3.08% (2) | 2.91% (61) | 0.930 | 2.63%(1) | 2.31%(20) | 0.898 |
Developmental | 13.85% (9) | 3.65% (77) *** | 0.000 | 15.79%(6) | 3.93%(34) *** | 0.001 |
Rates by Gender, % (n) | Likelihood of Unmet Need of Transgender Compared to Cisgender People, OR (95% CI) | |||
---|---|---|---|---|
Unmet Need | Transgender | Cisgender | Unadjusted | Adjusted + |
Unable to see doctor as needed | 39.29% (22) | 11.91% (220) *** | 4.79 (2.75–8.33) *** | 4.12 (2.29–7.43) *** |
Unable to get prescription medication as needed | 35.71% (20) | 16.58% (306) *** | 2.79 (1.60–4.90) *** | 3.00 (1.67–5.40) *** |
Unable to see a specialist as needed | 31.58% (18) | 11.7% (217) *** | 3.46 (1.95–6.16) ** | 2.77 (1.50–5.11) ** |
Unable to get all the dental services needed | 47.27% (26) | 28.97% (535) ** | 2.20 (1.28–3.77) ** | 2.92 (1.63–5.22) *** |
Unable to get all the preventative services needed | 14.29% (8) | 10.51% (194) | 1.42 (0.66–3.04) | 1.41 (0.65–3.08) |
Reported at least one unmet need | 66.67%(38) | 43.6%(865) ** | 2.59 (1.48–4.52) ** | 2.70 (1.52–4.82) ** |
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Mulcahy, A.; Streed, C.G., Jr.; Wallisch, A.M.; Batza, K.; Kurth, N.; Hall, J.P.; McMaughan, D.J. Gender Identity, Disability, and Unmet Healthcare Needs among Disabled People Living in the Community in the United States. Int. J. Environ. Res. Public Health 2022, 19, 2588. https://doi.org/10.3390/ijerph19052588
Mulcahy A, Streed CG Jr., Wallisch AM, Batza K, Kurth N, Hall JP, McMaughan DJ. Gender Identity, Disability, and Unmet Healthcare Needs among Disabled People Living in the Community in the United States. International Journal of Environmental Research and Public Health. 2022; 19(5):2588. https://doi.org/10.3390/ijerph19052588
Chicago/Turabian StyleMulcahy, Abigail, Carl G. Streed, Jr., Anna Marie Wallisch, Katie Batza, Noelle Kurth, Jean P. Hall, and Darcy Jones McMaughan. 2022. "Gender Identity, Disability, and Unmet Healthcare Needs among Disabled People Living in the Community in the United States" International Journal of Environmental Research and Public Health 19, no. 5: 2588. https://doi.org/10.3390/ijerph19052588