title: Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey.
abstract: OBJECTIVE
  Transgender, transsexual, or transitioned (trans) people have reported avoiding medical care because of negative experiences or fear of such experiences. The extent of trans-specific negative emergency department (ED) experiences, and of ED avoidance, has not been documented.
  
  
  METHODS
  The Trans PULSE Project conducted a survey of trans people in Ontario, Canada (n=433) in 2009 to 2010, using respondent-driven sampling, a tracked network-based method for studying hidden populations. Weighted frequencies and bootstrapped 95% confidence intervals (CIs) were estimated for the trans population in Ontario and for the subgroup (n=167) reporting ED use in their felt gender.
  
  
  RESULTS
  Four hundred eight participants completed the ED experience items. Trans people were young (34% aged 16 to 24 years and only 10% >55 years); approximately half were female-to-male and half male-to-female. Medically supervised hormones were used by 37% (95% CI 30% to 46%), and 27% (95% CI 20% to 35%) had at least 1 transition-related surgery. Past-year ED need was reported by 33% (95% CI 26% to 40%) of trans Ontarians, though only 71% (95% CI 40% to 91%) of those with self-reported need indicated that they were able to obtain care. An estimated 21% (95% CI 14% to 25%) reported ever avoiding ED care because of a perception that their trans status would negatively affect such an encounter. Trans-specific negative ED experiences were reported by 52% (95% CI 34% to 72%) of users presenting in their felt gender.
  
  
  CONCLUSIONS
  This first exploratory analysis of ED avoidance, utilization, and experiences by trans persons documented ED avoidance and possible unmet need for emergency care among trans Ontarians. Additional research, including validation of measures, is needed.
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada. Electronic address: greta.bauer@schulich.uwo.ca.
authors.forename: Greta R
authors.initials: GR
authors.lastname: Bauer
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Ayden I
authors.initials: AI
authors.lastname: Scheim
authors.affiliation: Department of Family and Community Medicine, University of California San Francisco and the LA Gay and Lesbian Center, Los Angeles, CA.
authors.forename: Madeline B
authors.initials: MB
authors.lastname: Deutsch
authors.affiliation: Department of Emergency Medicine, St. Joseph's Healthcare, and the Department of Medicine, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Carys
authors.initials: C
authors.lastname: Massarella
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011287:Prejudice / Q000523:psychology; D063106:Transgender Persons / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult