Access to Health Care for Transgender and Gender-Diverse Adults in Urban and Rural Areas in the United States

Hannah MacDougall, Carrie Henning-Smith, Gilbert Gonzales, Austen Ott

Research output: Contribution to journalArticlepeer-review


The objective of this study is to examine access to care based on gender identity in urban and rural areas, focusing on transgender and gender diverse (TGD) populations. Data on TGD (n = 1,678) and cisgender adults (n = 403,414) from the 2019 to 2020 Behavioral Risk Factor Surveillance System were used. Outcome measures were four barriers to care. We conducted bivariate and multivariable logistic regressions to assess associations between access, rurality, and gender identity. Bivariate results show that TGD adults were significantly more likely to experience three barriers to care. In multivariable models, TGD adults were more likely to delay care due to cost in the full sample (adjusted odds ratio [AOR]: 2.00, p <.001), rural subsample (AOR: 2.14, p <.01), and urban subsample (AOR: 1.97, p <.01). This study revealed greater barriers to care for TGD adults, with the most frequent barriers found among rural TGD adults. Increased provider awareness and structural policy changes are needed to achieve health equity for rural TGD populations.

Original languageEnglish (US)
JournalMedical Care Research and Review
StateAccepted/In press - 2023

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), US Department of Health and Human Services (HHS) under PHS Cooperative Agreement No. 5U1CRH03717. This research was also supported by the NIH National Center for Advancing Translational Sciences, grant UL1TR002494.

Publisher Copyright:
© The Author(s) 2023.


  • health access
  • rural
  • transgender

PubMed: MeSH publication types

  • Journal Article


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