Improving Health Equity and Quality for Transgender and Non-Binary Adults through Community-Based Participatory Research at an Academic Medical Center

Nationally, transgender and gender non-binary patients – people whose gender identity differs from their sex assigned at birth – face increased barriers to accessing healthcare and utilize medical care at a lower rate than cisgender populations.46 Stigma by healthcare professionals and establishments, distrust of the medical system by transgender clients, limited numbers and geographic distribution of qualified providers, and exclusion from health insurance plans all contribute to this disparity.7-10 As a result, transgender/non-binary youth and adults experience higher rates of psychologic morbidity, suicidal ideation and attempts, substance abuse, and HIV/AIDS than the United States cisgender population.1,11-13 Indeed, in the 2015 United States Transgender Survey – a national sample of 27,715 transgender/non-binary adults – 25% of respondents reported problems with insurance, 33% did not see a doctor when needed because they couldn’t afford it, and 23% did not see a doctor out of fear of being mistreated.1 In this sample, 40% of respondents had attempted suicide once in their lifetime – nine times the rate in the United States cisgender population (4.6%).1 Data from Chicago and Illinois reflect national trends. For example, 39.4% of transgender/non-binary adults in Chicago report psychological distress in the past month, compared to 15.3% of cisgender adults.2 The Chicago Department of Public Health estimates that 0.5% of the adult population in Chicago and 0.51% of the adult population in Illinois is transgender/non-binary.2 Recent advocacy and legislation in the City of Chicago and State of Illinois have increased insurance coverage for transgender healthcare services.14 However, access to and utilization of surgical, medical, and preventive care remains limited.