Abstract
BACKGROUND: There is limited information about care experiences and health outcomes among transgender, gender-nonconforming, and nonbinary (TGNCNB) individuals with cancer. This study quantifies experienced health care discrimination among TGNCNB individuals living with cancer and its impact on their health. METHODS: This cross-sectional analysis used data from the All of Us Research Program on individuals with cancer. The authors performed propensity score matching (1:5) to balance TGNCNB and cisgender individuals by sociodemographic factors and cancer site. Health care discrimination and health were assessed using the Discrimination in Medical Settings Scale and the Overall Health survey. They used multivariable logistic regression models to adjust for sociodemographic characteristics. RESULTS: The cohort included 1476 participants, of which 246 (17%) identified as TGNCNB. TGNCNB participants had greater odds of reporting feeling unheard by providers (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.79-3.17), treated with less respect (OR, 2.61; 95% CI, 1.91-3.57), receiving poorer service (OR, 2.39; 95% CI, 1.73-3.31), and providers acting afraid (OR, 2.32; 95% CI, 1.37-3.93) compared to their cisgender counterparts. In adjusted models, TGNCNB identity was associated with increased odds of experiencing any health care discrimination (OR, 2.42; 95% CI, 1.81-3.25), and discrimination was associated with self-reported poor health (OR, 3.24; 95% CI, 2.58-4.07). DISCUSSION: The findings of this study suggest that in the TGNCNB population, increased rates of health care discrimination are associated with poorer health outcomes, which may perpetuate medical mistrust and decrease patient-centric quality of care overall. Future research and policy efforts should identify actionable interventions to advance equitable cancer care for TGNCNB individuals.