Healthcare avoidance and delay among trans adults: Associations with mental and behavioral health outcomes.

Introduction: Healthcare avoidance and delay (HAD) is prevalent among transgender (trans) populations. This study sought to identify patterns of HAD and examine associations between HAD and 5 behavioral health outcomes among trans adults: depression, anxiety, tobacco and alcohol use, and intimate partner violence (IPV).

Methods: This study used survey data collected in 2023 from 789 trans adults in Washington state. In 2024, a latent class analysis using four indicators of HAD was conducted. Adjusted multinomial models predicted class membership by 10 demographic and socioeconomic characteristics and adjusted logistic regression models predicted each outcome by class.

Results: The sample was predominantly White (60.3%), trans women (82.7%), and financially stable (59.6%). Most participants were assigned to the Low HAD class (58.9%), followed by the Stigma HAD class (33.6%), and Combined HAD class (i.e., both cost and stigma, 7.5%). Combined HAD class members were younger, more likely to be trans men or nonbinary, and occupied lower socioeconomic positions than other classes. Compared to the Low HAD class, Stigma HAD class members were more likely to live in rural or suburban areas. Combined HAD and Stigma HAD class membership was associated with increased odds of depressive symptoms, anxious symptoms, and IPV.

Conclusions: While the demographic profiles of the Combined HAD and Stigma HAD classes were distinct, the behavioral health of these groups was comparable. Preventing HAD among trans adults and mitigating its potential health consequences requires greater attention to healthcare affordability and health services acceptability.