Systematic Review and Meta Analyses: A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities

Background: Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience significant health inequalities. Located within a European Commission funded pilot project, this paper presents a review of the health inequalities faced by LGBTI people and the barriers health professionals encounter when providing care. Methods: A narrative synthesis of 57 papers including systematic reviews, narrative reviews, meta-analyses and primary research. Literature was searched in Cochrane, Campbell Collaboration, Web of Science, CINAHL, PsychINFO and Medline. The review was undertaken to promote understanding of the causes and range of inequalities, as well as how to reduce inequalities. Results: LGBTI people are more likely to experience health inequalities due to heteronormativity or heterosexism, minority stress, experiences of victimization and discrimination, compounded by stigma. Inequalities pertaining to LGBTI health(care) vary depending on gender, age, income and disability as well as between LGBTI groupings. Gaps in the literature remain around how these factors intersect to influence health, with further large-scale research needed particularly regarding trans and intersex people. Conclusion: Health inequalities can be addressed via changes in policy, research and in practice through health services that accommodate the needs of LGBTI people. With improved training to address gaps in their knowledge of LGBTI health and healthcare, health professionals should work in collaboration with LGBTI people to address a range of barriers that prevent access to care. Through structural change combined with increased knowledge and understanding, services can potentially become more inclusive and equally accessible to all

Health and health care access in the US transgender population health (TransPop) survey

BACKGROUND: Probability and nonprobability-based studies of U.S. transgender persons identify different disparities in health and health care access. OBJECTIVES: We used TransPop, the first U.S. national probability survey of transgender persons, to describe and compare measures of health and health access among transgender, nonbinary and cisgender participants. We directly compared results with 2015 U.S. Transgender Survey (USTS) data and with previously published analyses from the Behavioral Risk Factor Surveillance System (BRFSS). METHODS: All participants were screened by Gallup, Inc., which recruited a probability sample of U.S. adults. Transgender people were identified using a two-step screening process. Eligible participants completed self-administered questionnaires (transgender n=274, cisgender n=1,162). We obtained weighted proportions/means, then tested for differences between gender groups. Logistic regression was performed to evaluate associations. Bivariate analyses were conducted using the weighted USTS data set for shared variables in USTS and TransPop. RESULTS: Transgender participants were younger and more racially diverse compared to cisgender participants. Despite equally high insurance coverage, transgender people more often avoided care due to cost. Nonbinary persons were less likely to access transgender related health care providers/clinics than transgender men and women. Transgender respondents more often rated health as fair/poor, with more poor physical and mental health days than cisgender respondents. Health conditions including HIV, emphysema, and ulcer, were higher among transgender people. TransPop and USTS, unlike BRFSS-based analyses, showed no differences in health or health access outcomes. DISCUSSION: Transgender persons experience health access disparities centered on avoidance of care due to cost beyond insured status. Nonbinary persons appear to have distinct health/health access patterns. Health disparities appear consistent with models of minority stress. Despite different sampling methods, USTS and TransPop appear more similar than BRFSS across measures of health and health access. CONCLUSION: Future research should elucidate health care costs for transgender and nonbinary people, while addressing methodologic issues in national studies of transgender health