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Health disparities in the transgender population

Health disparities in the transgender population. Final Project for Epidemiology N395M Amy Daly, MBA, BSN, RN CCRN. Historical context. Less likely to seek preventative care Fear of hostile healthcare environment Untreated or undertreated chronic and acute conditions. Historical context.

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Health disparities in the transgender population

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  1. Health disparities in the transgender population Final Project for Epidemiology N395M Amy Daly, MBA, BSN, RN CCRN

  2. Historical context • Less likely to seek preventative care • Fear of hostile healthcare environment • Untreated or undertreated chronic and acute conditions

  3. Historical context Healthcare provider barriers include: • Attitudes and behaviors • Heteronormative care • Refusal of care • Inadequacy of examinations • Lack of knowledge about transgender people

  4. Description Physical: Untreated medical conditions Psychological: Unsafe environment to reveal personal information Social: Word of mouth referrals and treatment of conditions Occupational: Lack of insurance due to unprotected employment status Environmental: Social stigma associated with trans identity

  5. Scope of problem Significant gaps in knowledge Transgender individuals are not routinely counted EHRs may not reflect transgender identity

  6. Scope of Problem Incidence • 30% of surveyed trans people delay or avoid care • Reports of as many as 80% of trans identified individuals do not have a primary care provider • 70% of transgender people report discrimination or harassment in a healthcare setting

  7. Scope of the problem Morbidity • 20% higher rates of depression • Increased rates of cardiovascular disease, hypertension and diabetes • Conflicting information about the number of affected individuals due to later detection

  8. Scope of the problem Mortality • Conflicting reports about cardiovascular and oncologic diseases • Later detection of cancers lead to poorer outcomes • 20% higher mortality associated with suicide

  9. Cause and risk factors Cause Avoidance of health care settings due to fear creates barriers to care Risk factors • Decreased rates of preventative care screening • Increased risk taking behaviors • Use of unapproved hormone regimens

  10. Prevention: Guided by WHO’s Public Health Operation 5 Primary • Administer vaccines such as influenza, pneumonia, HPV • Hormone therapy guided by evidence based standards to avoid complications • Screening for reproductive cancers • Screening for STI and HIV • Education for medical and nursing to increase access to preventative care

  11. Prevention Secondary • Access to STI and HIV treatment • Early treatment of reproductive cancers • Early management of chronic disease such as hypertension, cardiovascular conditions, diabetes

  12. Prevention Tertiary • Access to affordable health insurance • Stable employment to increase accessibility of treatments • Cost prohibitive treatment for people with unstable employment

  13. Prevention Current legislation The Affordable Care Act Current American Nurses Association Position Statement Nursing Advocacy for LGBTQ+ Populations

  14. Summary • Transgender people are a highly stigmatized population that suffers fromdiscrimination and lack of legal protections • Transgender people face barriers to healthcare access • Healthcare access barriers can be overcome by offering culturally congruent care and advocating forhealthcare protections Be a decent human being.

  15. References Association of American Medical Colleges. (2014). Implementing curricular and institutional climate changes to improve health care for individuals who are LGBT, gender nonconforming, or born with DSD. Washington, DC: Association of American Medical Colleges. Retrieved from https://members.aamc.org/eweb/upload/Executive%20LGBT%20FINAL.pdf Bauer, G., Hammond, R., Travers, R., Kaay, M., Hohenadel, K., & Boyce, M. (2009). How erasure impacts health care for transgender people. JANAC: Journal Of The Association Of Nurses In AIDS Care, 20(5), 348-361. doi:10.1016/j.jana.2009.07.004 Center for Disease Control (n.d.) Prevention: Picture of America. Retreived from: https://www.cdc.gov/pictureofamerica/pdfs/picture_of_america_prevention.pdf

  16. Center of Excellence [CoE] for Transgender Health, Department of Family and Community Medicine (2016) . Guidelines for the primary and gender-affirming care of transgender and gender-nonconforming people (2nd ed.). San Francisco, CA : University of California. Retrieved from http://transhealth.ucsf.edu/guidelines Chipkin, S. R., & Kim, F. (2017). Ten most important things to know about caring for transgender patients. American Journal Of Medicine, 130(11), 1238-1245. doi:10.1016/j.amjmed.2017.06.019 Cicero, E. C., & Wesp, L. M. (2017). Supporting the health and well-being of transgender students. Journal Of School Nursing (Sage Publications Inc.), 33(2), 95-108. doi:10.1177/1059840516689705

  17. Enhancing transgender health care. (2017). American Journal of Public Health, 107(2), 230-231. doi:10.2105/AJPH.2016.1072230 Giblon, R., & Bauer, G. R. (2017). Health care availability, quality, and unmet need: A comparison of transgender and cisgender residents of Ontario, Canada. BMC Health Services Research, 171-10. doi:10.1186/s12913-017-2226-z Feldman, J., Brown, G. R., Deutsch, M. B., Hembree, W., Meyer, W., Meyer-Bahlburg, H. F. L., … TʼSjoen, G. (2016). Priorities for transgender medical and healthcare research. Current Opinion in Endocrinology, Diabetes & Obesity, 23(2), 180–187. https://doi-org.ezproxy.lib.utexas.edu/10.1097/MED.0000000000000231

  18. Gonzales, G., & Henning-Smith, C. (2017). Barriers to care among transgender and gender nonconforming adults. Milbank Quarterly, 95(4), 726-748. doi:10.1111/1468-0009.12297 Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC : The National Academies Press. Retrieved from http://www.nationalacademies.org/hmd/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx Jaffee, K. D., Shires, D. A., & Stroumsa, D. (2016). Discrimination and delayed health care among transgender women and men: Implications for improving medical education and health care delivery. Medical Care, 54(11), 1010-1016.

  19. Kielich, A. (2018). Transgender employment discrimination in Texas: Dallas sex discrimination lawyer. Retrieved from: https://www.kielichlawfirm.com/transgender-employment-discrimination-in-texas/ Korpaisarn, S., & Safer, J. D. (2018). Gaps in transgender medical education among healthcare providers: A major barrier to care for transgender persons. Reviews in Endocrine and Metabolic Disorders, , 1-5. doi:10.1007/s11154-018-9452-5 Kosenko, K., Rintamaki, L., Raney, S., & Maness, K. (2013). Transgender patient perceptions of stigma in health care contexts. Medical Care, 51(9), 819-822. doi:10.1097/MLR.0b013e31829fa90d National Center for Transgender Health Equality (2017). Know your rights: Healthcare. Retrieved from: https://transequality.org/know-your-rights/healthcare

  20. Noonan, E. J., Sawning, S., Combs, R., Weingartner, L. A., Martin, L. J., Jones, V. F., & Holthouser, A. (2018). Engaging the Transgender Community to Improve Medical Education and Prioritize Healthcare Initiatives. Teaching & Learning In Medicine, 30(2), 119-132. doi:10.1080/10401334.2017.1365718 Nursing Advocacy for LGBTQ+ Populations (2018). American Nurses Association. Retrieved from: https://www.nursingworld.org/~48dc8a/globalassets/docs/ana/statement-in-support-of-equality-and-human-rights-for-the-lgbtq-community-7_28_17.pdf. Poteat, T., German, D., & Kerrigan, D. (2013). Managing uncertainty: A grounded theory of stigma in transgender health care encounters. Social Science & Medicine, 8422-29. doi:10.1016/j.socscimed.2013.02.019

  21. Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). Barriers to healthcare for transgender individuals. Current Opinion In Endocrinology, Diabetes & Obesity, 23(2), 168-171. doi:10.1097/MED.0000000000000227 The Medical Care of Transgender Persons (2015). Fenway Health. Retrieved from: http://lgbthealtheducation.org/wp-content/uploads/COM-2245-The-Medical-Care-of-Transgender-Persons.pdf. World Health Organization (2018). EPHO5: Disease prevention, including early detection of illness. Retrieved from: http://www.euro.who.int/en/health-topics/Health-systems/public-health-services/policy/the-10-essential-public-health-operations/epho5-disease-prevention,-including-early-detection-of-illness2

  22. World Health Organization (2013). Improving the Health Care of Lesbian, Gay, Bisexual and Transgender People (EB133/6). World Health Organization, Geneva, Switzerland. World Professional Association for Transgender Health (n.d.) Retrieved from https://www.wpath.org.

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