Journal article
State-level heterogeneity in associations between structural stigma and individual healthcare access: A multilevel analysis of transgender adults in the United States
Journal of health services research & policy, pp 109-118
Apr 2023
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objective
State-level variation in how restrictive policies affect health care access for transgender populations has not been widely studied. Therefore, we assessed the association between structural stigma and four measures of individual health care access among transgender people in the United States, and the extent to which structural stigma explains state-level variability.
Methods
Data were drawn from the 2015–2019 Behavioral Risk Factor Surveillance System and the Human Rights Campaign’s State Equality Index. We calculated weighted proportions and conducted multilevel logistic regression of individual heterogeneity and discriminatory accuracy.
Results
An increase in the structural stigma score by one standard deviation was associated with lower odds of health care coverage (OR = 0.80; 95% CI: 0.66, 0.96) after adjusting for individual-level confounders. Approximately 11% of the total variance for insurance coverage was attributable to the state level; however, only 18% of state-level variability was explained by structural stigma. Adding Medicaid expansion attenuated the structural stigma-insurance association and explained 22% of state-level variation in health insurance. For the remaining outcomes (usual source of care, routine medical check-up, and cost-related barriers), we found neither meaningful associations nor considerable between-state variability.
Conclusions
Our findings support the importance of Medicaid expansion and transgender-inclusive antidiscrimination protections to enhance health care insurance coverage. From a measurement perspective, however, additional research is needed to develop and validate measures of transgender-specific structural stigma to guide future policy interventions.
Metrics
Details
- Title
- State-level heterogeneity in associations between structural stigma and individual healthcare access: A multilevel analysis of transgender adults in the United States
- Creators
- Nguyen K Tran - Drexel UniversityKellan E Baker - Johns Hopkins MedicineElle Lett - Raymond and Ruth Perelman School of Medicine at the University of PennsylvaniaAyden I Scheim - Drexel University
- Publication Details
- Journal of health services research & policy, pp 109-118
- Publisher
- SAGE Publications
- Number of pages
- 10
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000847842100001
- Scopus ID
- 2-s2.0-85137247242
- Other Identifier
- 991019173807704721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Health Policy & Services