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LGBT Health. 2014 Sep 1;1(3):177-184.

Transgender Health Disparities: Comparing Full Cohort and Nested Matched-Pair Study Designs in a Community Health Center.

Author information

1
Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA ; The Fenway Institute at Fenway Health, Boston, MA, USA.
2
The Fenway Institute at Fenway Health, Boston, MA, USA.
3
Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA ; The Fenway Institute at Fenway Health, Boston, MA, USA ; Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA.

Abstract

PURPOSE:

U.S. health surveillance systems infrequently include measures to identify transgender respondents or monitor the health of this underserved and marginalized population.

METHODS:

From 2001-2002, transgender and non-transgender adults were sampled at a Massachusetts clinic. Health differences were formatively examined by transgender identity using a cross-sectional, clinic-based sample (n=2,653); and a nested matched-pair subsample (n=155).

RESULTS:

Both designs produced virtually identical findings: (1) the prevalence of HIV, substance abuse, and smoking did not differ significantly for transgender and non-transgender patients; (2) transgender patients were more likely to endorse a lifetime suicide attempt and ideation compared to non-transgender patients (p<0.05); (3) transgender patients disproportionately reported social stressors (violence, discrimination, childhood abuse) relative to non-transgender patients (p<0.05).

CONCLUSION:

Findings suggest that a nested design may provide an effective methodology for using clinical data to study transgender health, and underscore the need for routine collection of gender identity in clinical settings.

KEYWORDS:

Health disparity; gender identity; methods; study design; transgender

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