Avoidance of primary healthcare among transgender and non-binary people in Canada during the COVID-19 pandemic

Abigail Tami, Tatiana Ferguson, Greta R. Bauer, Ayden I. Scheim

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Transgender (trans) and non-binary people experience barriers to culturally competent healthcare and many have reported avoiding care. COVID-19 and related mitigation strategies may have exacerbated avoidance, and poor mental health may be bidirectionally related to avoiding care. This study estimated the prevalence of primary care avoidance during the pandemic in a national sample of trans and non-binary people in Canada with a primary care provider and examined the association between poorer self-rated mental health and avoidance. In Fall 2019, Trans PULSE Canada collected multi-mode survey data from trans and non-binary people. In September to October 2020, 820 participants completed a COVID-19-focused survey. In this cross-sectional analysis, multivariable logistic regression models estimated odds ratios adjusted for confounders and weighted to the 2019 sample. The analysis included 689 individuals with a primary healthcare provider, of whom 61.2% (95% CI: 57.2, 65.2) reported fair or poor mental health and 25.7% (95% CI: 22.3, 29.2) reported care avoidance during the pandemic. The most common reason for avoidance was having a non-urgent health concern (72.7%, 95% CI: 65.9, 79.5). In adjusted analyses, those with fair or poor mental health had higher odds of avoiding primary care as compared to those with good to excellent mental health (adjusted odds ratio [AOR] = 2.37; 95% CI: 1.50, 3.77). This relationship was similar when excluding COVID-related reasons for avoidance (AOR = 2.52; 95% CI: 1.52, 4.17). Expansion of virtual communication may enhance primary care accessibility, and proactively assessing mental health symptoms may facilitate connections to gender-affirming mental health services.

Original languageEnglish (US)
Article number101789
JournalPreventive Medicine Reports
StatePublished - Jun 2022
Externally publishedYes

Bibliographical note

Funding Information:
The Trans PULSE Canada Study Team would like to acknowledge and thank the trans and non-binary people who have generously shared their time and experience with us. The Trans PULSE Canada Study was funded by the Canadian Institutes of Health Research (Funding Reference Number PJT-159690).

Publisher Copyright:
© 2022 The Authors


  • Healthcare avoidance
  • Mental health
  • Non-binary
  • Primary care
  • Transgender

PubMed: MeSH publication types

  • Journal Article


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