An Intersectional Analysis of Transgender and Nonbinary Young Adult Experiences of Mistreatment and Respect in Healthcare

Despite high prevalence of healthcare discrimination among transgender and nonbinary (TNB) people, limited quantitative research has considered healthcare discrimination experiences of TNB young adults considering within-group heterogeneity along multiple axes. We conducted a cross-sectional secondary analysis of data from TNB young adults, ages 18 to 25 years, from the 2015 United States Transgender Survey ( N = 10,638). Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy was used to explore the intersections of gender, sex assigned at birth, race and ethnicity, and sexual orientation on experiences of mistreatment in healthcare settings, and mistreatment and respect from providers. Predicted prevalence (PP) and variance partition coefficients (VPC; variability across vs. within intersectional strata) were estimated. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated for main effects. In the full sample, TNB young adults reported healthcare setting mistreatment (5.7%), provider mistreatment (20%), and provider respect (43.9%). There was substantial variation in prevalence across intersectional strata for all healthcare indicators: healthcare setting mistreatment ( PP = 3.1%–13.4%, VPC = 5.6%), provider mistreatment ( PP = 12.5%–27.7%, VPC = 5.3%), and provider respect ( PP = 17.9%–76.9%, VPC = 24%), though only additive between these identity dimensions were significant. In terms of these additive patterns, nonbinary young adults had lower odds of provider mistreatment (aOR = 0.48, 95% CI [0.42, 0.56]) and provider respect (aOR = 0.14 [0.12, 0.16]) than young adults with binary gender identities. Findings revealed important heterogeneity in healthcare experiences among TNB young adults and assessed experiences of both mistreatment and respect in healthcare settings. Future inquiries into TNB healthcare experiences should utilize critical intersectional lenses.