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


CONCLUSIONS
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.
Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA ; The Fenway Institute at Fenway Health, Boston, MA, USA.
Sari L
SL
Reisner
The Fenway Institute at Fenway Health, Boston, MA, USA.
Jaclyn M
JM
White
The Fenway Institute at Fenway Health, Boston, MA, USA.
Judith B
JB
Bradford
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.
Matthew J
MJ
Mimiaga
Health disparity; gender identity; methods; study design; transgender