Background : Although prior studies have noted the negative experiences within health care settings transgender and non-binary (TNB) individuals may encounter, there is still a paucity of research on the within-group differences in experiences of health care discrimination among TNB people of color (POC). The goal of this study is to identify latent subgroups of TNB POC based on various experiences of discrimination in health care settings.
Methods : Using data from the U.S. Transgender Survey (n = 1368), this study uses latent class analysis (LCA) to identify mutually exclusive subgroups of TNB POC based on their responses to observed binary variables. This person-centered approach allows us to explore subgroups of TNB POC with shared experiences of discrimination. We chose five indicators to identify subgroups of health care discrimination including: 1) having to teach one's provider about transgender people to receive appropriate care; 2) being denied transgender related treatment; 3) being asked invasive questions by a provider; 4) having a provider use harsh language; and 5) being verbally harassed in a health care setting. Additionally, we examined the association of demographic and health indicators including “outness” in health care settings, and visual conformity.
Results : Five subgroups were found: the multi-discrimination subgroup (10%) marked by a high probability of all discrimination indicators; the educators subgroup (33%) characterized by having to teach one's provider about TNB people to receive appropriate care; the educators and invasiveness subgroup (36%) marked by a high probability of having to teach one's provider and being asked unnecessary and/or invasive questions about transgender status that were not related to the reason for visit; the educators and denied treatment subgroup (11%) was characterized by a high probability of having to teach one's provider and having doctor or other health care provider refusing transgender-related care; and the verbal harassment subgroup (10%) marked by a high probability of endorsing verbal harassment in a health care setting (such as a hospital, office, clinic). The multi-discrimination subgroup was more likely to be comprised of participants who identified as American Indian/Alaska Native, and were “out” as transgender in health care settings; the educators and invasiveness subgroup was less likely to be comprised of participants who identified as transgender women; the educators and denied treatment subgroup was less likely to be comprised of non-binary participants who were assigned female at birth; and the verbal harassment subgroup was more likely to be comprised of non-binary participants who were assigned female at birth and were less likely to be "out" in health care settings.
Conclusions : Few studies have employed LCA to identify groups of TNB POC based on their reported experiences of discrimination in health care settings. Our findings have implications for health care practice, policy, and practitioners’ education. Factors including gender identity, race/ethnicity, and outness must be considered in order to assess risk of discrimination and inform improvements in health care access, as well as interventions to prevent discrimination.