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Assessment of health conditions and health service use among transgender patients in Canada

Abramovich A, de Oliveira C, Kiran T, Iwajomo T, Ross LE, Kurdyak P. JAMA Netw Open. 2020; 3(8):e2015036. Epub 2020 Aug 28. DOI:

Importance — Transgender individuals experience stigma, discrimination, and socioeconomic disadvantages, leading to a myriad of poor health outcomes and high rates of disease burden; however, transgender health continues to be an understudied area.

Objective — To examine sociodemographic characteristics, health conditions, and health service utilization patterns among transgender individuals compared with the general population.

Design, Setting, and Participants — This cross-sectional study of 2085 transgender individuals from 3 large cities in Ontario, Canada, compared characteristics and health service use among transgender individuals with the general population in the province. Transgender individuals were identified through data obtained from 4 outpatient community and hospital clinics, which were linked with health administrative data between January 2012 and December 2016. Data were analyzed between October 2018 and May 2020. Individuals were age-matched 1:5 to a random 5% sample of the general Ontario population (10 425 individuals).

Main Outcomes and Measures — Sociodemographic variables, health service use, and chronic conditions among transgender individuals and the general population were compared.

Results — This study included a sample of 2085 transgender individuals with a mean (SD) age of 30.40 (12.81) years; 771 (37.0%) identified as transgender women. Compared with 10 425 cisgender controls, trangender individuals were more likely to live in lower-income neighborhoods (lowest-income quintile: 625 [30.0%] vs 2197 [21.1%]; P < .001) and experience chronic physical and mental health conditions, including higher rates of asthma (489 [23.5%] vs 2034 [19.5%]; P < .001), diabetes (115 [5.5%] vs 352 [3.4%]; P < .001), chronic obstructive pulmonary disease (51 [2.4%] vs 156 [1.5%]; P < .001), and HIV (34 [1.6%] vs 12 [0.1%]; P < .001). Comorbid chronic health conditions were higher among the transgender population compared with the cisgender population (702 [33.7%] vs 2941 [28.2%]; P < .001). Transgender individuals also had higher health service use compared with the general population, particularly for mental health and self-harm, including mean (SD) number of psychiatrist visits between January 2012 and December 2016 (8.25 [23.13] vs 0.93 [9.57]; standardized difference, 5.84).

Conclusions and Relevance — This study found higher rates of mental and physical comorbidities and higher health service use among transgender individuals compared with cisgender individuals. Further research should explore reasons for these findings. Clinicians caring for transgender individuals should be aware of the high potential for mental health issues and self-harm.

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