Health care access among transgender and nonbinary people in Canada, 2019: a cross-sectional survey

• Published in: CMAJ Open
• Main Authors: Scheim, Ayden I., Coleman, Todd, Lachowsky, Nathan J., Bauer, Greta R.
• Format: Article in Journal/Newspaper
• Language: English
• Published: CMAJ Open 2021
• Subjects: Canada; Newfoundland
• Online Access: http://hdl.handle.net/1828/13835; https://doi.org/10.9778/cmajo.20210061

The authors thank the 2873 trans and nonbinary people who participated in the survey and the more than 100 individuals who contributed to the project. The authors also thank Dr. Julia Temple Newhook for feedback on the interpretation. Background: Previous Canadian studies have identified problems regarding health care access for transgender (trans) and nonbinary people, but all-ages national data have been lacking. This study describes access to care among trans and nonbinary people in Canada, and compares health care access across provinces or regions. Methods: We conducted a bilingual, multimode cross-sectional survey (Trans PULSE Canada) from July 26 to Oct. 1, 2019. We recruited trans and nonbinary people aged 14 years and older using convenience sampling. We assessed 5 outcomes: having a primary care provider, having a primary care provider with whom the respondent was comfortable discussing trans health issues, past-year unmet health care need, medical gender affirmation status, and being on a wait-list to access gender-affirming medical care. Average marginal predictions were estimated from multivariable logistic regression models with multiply imputed data. Results: The survey included 2873 participants, and 2217 surveys were analyzed after exclusions. Of the 2217 trans and nonbinary respondents, most had a primary care provider (n = 1803; 81.4%, 95% confidence interval [CI] 79.8%–83.0%), with model-predicted probabilities from 52.1% (95% CI 20.2%–84.1%) in the territories to 92.9% (95% CI 83.5%–100.0%) in Newfoundland and Labrador. Of the respondents, 52.3% (n = 1150; 95% CI 50.3%–54.2%) had a primary care provider with whom they were comfortable discussing trans health issues, and 44.4% (n = 978; 95% CI 42.3%–46.4%) reported an unmet health care need. Among participants who needed gender-affirming medical treatment (n = 1627), self-defined treatment completion ranged from an estimated 16.8% (95% CI 0.6%–32.5%) in Newfoundland and Labrador to 59.1% (95% CI 52.5%– 65.6%) in Quebec. Of those who needed ...