Reported Emergency Department Avoidance, Use, and Experiences of Transgender Persons in Ontario, Canada: Results From a Respondent-Driven Sampling Survey

TLDR

Transgender individuals often avoid medical care because of anticipated negative experiences, and further research is needed to validate related measures. This study sought to document the prevalence of emergency department avoidance and negative experiences among transgender persons in Ontario. Using respondent‑driven sampling, the Trans PULSE Project surveyed 433 transgender individuals in Ontario, estimating weighted frequencies and confidence intervals for ED use and experiences. Among participants (median age 34 % aged 16‑24, 10 % >55), 37 % used medically supervised hormones, 27 % had transition‑related surgery, 33 % reported past‑year ED need but only 71 % obtained care, 21 % avoided ED due to perceived trans stigma, and 52 % experienced negative ED encounters.

Abstract

Study objectiveTransgender, 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.MethodsThe 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.ResultsFour 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.ConclusionThis 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.