Healthcare Avoidance and Delay Among Trans Adults: Associations With Mental and Behavioral Health Outcomes.

introductionHealthcare avoidance and delay is prevalent among transgender (trans) populations. This study sought to identify patterns of healthcare avoidance and delay and examine their associations with 5 behavioral health outcomes among trans adults: depression, anxiety, tobacco and alcohol use, and intimate partner violence.

methodsThis study used survey data collected in 2023 from 789 trans adults in Washington state. Healthcare avoidance and delay was operationalized using latent class analysis with 4 indicators. Adjusted multinomial models predicted class membership by 10 demographic and socioeconomic characteristics, and adjusted logistic regression models predicted each outcome by class.

resultsThe sample was predominantly White (60.3%), trans women (82.7%), and financially stable (59.6%). Participants were assigned to one of 3 classes: Low Healthcare Avoidance and Delay (58.9%), Stigma Healthcare Avoidance and Delay class (33.6%), and Combined Healthcare Avoidance and Delay class (i.e., both cost and stigma, 7.5%). Combined members were younger, more likely to be trans men or nonbinary, and occupied lower socioeconomic positions than other classes. Stigma members were more likely to live in rural or suburban areas than the Low class. Stigma and Combined members were associated with increased odds of depressive symptoms, anxious symptoms, and intimate partner violence.

conclusionsAlthough the demographic profiles of the Combined Healthcare Avoidance and Delay and Stigma Healthcare Avoidance and Delay classes were distinct, the behavioral health of these groups was comparable. Preventing healthcare avoidance and delay among trans adults and mitigating its potential health consequences requires greater attention to health services affordability and acceptability.