The practice of emergency medicine/original research
Reported Emergency Department Avoidance, Use, and Experiences of Transgender Persons in Ontario, Canada: Results From a Respondent-Driven Sampling Survey

Presented at the Canadian Professional Association for Transgender Health Conference, September 2012, Winnipeg, Canada; and the Research to Policy Dialogue, Ontario Ministry of Health and Long-Term Care, October 2012, Toronto, Canada.
https://doi.org/10.1016/j.annemergmed.2013.09.027Get rights and content
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Study 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.

Conclusion

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.

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Supervising editor: Ellen J. Weber, MD

Author contributions: GRB conceived the study, obtained research funding, undertook data collection, and conducted the statistical analysis. GRB, AIS, and MBD drafted the article, and all authors contributed substantially to both its conceptualization and revision. GRB takes responsibility for the paper as a whole.

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist and provided the following details: This research was supported by an operating grant from the Canadian Institutes for Health Research, Institute of Gender and Health (MOP-106478).

Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc.