Transgender and Nontrans Patients Do Not Receive Statistically Different Quality Primary Care at Whitman-Walker Health, 2008–2016

Abstract

Purpose: Washington, DC, has the highest prevalence of transgender persons in the United States at 2.8%. Transgender persons in DC have lower income, less stable housing, and more HIV infection than nontrans persons. Data are scarce regarding primary care quality among trans persons. We provide a detailed analysis of transgender patients at Whitman-Walker Health, an HIV- and LGBT-focused community health center.Methods: We performed a retrospective electronic medical record review of transgender patients ≥18 years of age from 2008 to 2016, evaluating demographic factors, HIV status, gender-affirming care, and primary care quality indicators.Results: Of 20,097 patients, 1822 (9.0%) self-identify as transgender (62.9% trans female and 37.2% trans male), and 18,275 were nontransgender. Transgender patients are more likely to be young, white, HIV negative, and reside outside Washington, DC, than nontrans patients. Transgender patients are more likely to engage in primary care and have a similar likelihood of mammogram and colonoscopy screening than nontrans patients. Trans males are more likely to be privately insured, have lower rates of HIV testing than nontrans patients, and have higher rates of cervical Pap smears than cis females. Trans females have a high prevalence of HIV infection (26.6%).Conclusion: This is the largest single-center U.S. transgender cohort to date. Over a quarter of trans females are HIV positive, consistent with a national prevalence of 27.7%. Transgender and nontrans patients do not receive statistically different quality of primary care. Trans patients' high engagement in primary care may result from providing hormone therapy and primary care within a single provider visit.

Primary Care for Transgender Adolescents and Young Adults in Rhode Island: An Analysis of the all Payers Claims Database

“…Overall, our analysis suggests that TG/GD adolescents who are insured, accessing the healthcare system, and have at least one diagnosis code associated with gender dysphoria, receive similar, if not greater, levels of preventive health services compared to their cisgender peers. This aligns with previous studies using Medicare claims [19], Behavioral Risk Factor Surveillance System (BRFSS) data [33], and clinic-level data [34], which did not find a significant difference in primary care utilization between TG/GD and cisgender individuals.…”

Cancer screening attendance rates in transgender and gender-diverse patients: a systematic review and meta-analysis

“…The data represented cancer screening for four different anatomical parts. Eight studies described breast cancer [6–8,35,36,38,48,50], ten described cervical cancer [6–8,11,36,39,40,46,48,50], four described prostate cancer [7,9,10,50] and three described colorectal cancer [6,36,50]. Six articles reported results on multiple organs [6–8,36,48,50], therefore increasing the pool of data available for analysis.…”

“…Meta-analysis for UTD versus LT was performed separately for each of the four cancer screening categories to maximise data capture – i.e., breast, cervix, prostate, colorectal. 11 of 18 studies were added to our meta-analysis [6–11,35,36,39,46,50]. Seven of 18 studies [38,40,41,43,45,48,49] could not be included in the quantitative synthesis due to missing data or lack of control groups prohibiting the calculation of OR.…”

Cancer in Transgender and Gender-Diverse Persons

“…Similarly, a study conducted among transgender men in the greater Boston area showed that 77.1% of participants had received Papanicolaou tests in the past 3 years. Finally, a retrospective single-center study found that transgender men were more likely to have had a lifetime Papanicolaou test than were cisgender women.…”