In a groundbreaking study — the largest of its kind in Canada — co-authors and University of Toronto professors Alex Abramovich and Claire de Oliveira established that transgender individuals in Ontario are more likely to experience chronic health conditions.

In a memo, lead author Abramovich, who is a transgender man, explained that the paper “demonstrates the need to provide transgender competent and inclusive health care and the need to improve the capacity to identify transgender individuals in administrative health data, so that we can understand the factors underlying the high rates of disease burden.”

A lack of data on transgender health

Prior research on the health of the transgender community — a marginalized group estimated to account for 0.5 to 1.3 per cent of the adult population — has established a connection between the stigma and discrimination that the community faces and a generally poor state of health.

However, in the study, the authors posit that this aforementioned research lacks quantitative and systematic rigour for a variety of reasons, one being that the usage of sex designation data in Ontario’s general health care system — including OHIP — cannot reliably identify transgender individuals.

Through canvassing four clinics that specialize in serving the transgender population, the authors sought to remedy this lack of rigour. The authors carried out a cross-sectional study examining a population of 2,085 self-identified transgender individuals and 10,425 age-matched controls, where five cisgender controls were matched to a transgender person of the same age.

A number of sociodemographic variables, including age, income, and migrant status were measured in all participants and compared against medical and health care usage variables, such as physician and specialist visits and hospitalizations.

Disproprotionately physical and psychiatric health conditions

The results of the study were appalling and grave. A number of clinical comorbidities — the simultaneous presence of multiple chronic conditions — were found to be significantly higher in transgender patients compared to cisgender controls; these include asthma at 23.5 per cent versus 19.5 per cent, and diabetes at 5.5 per cent compared to 3.4 per cent. HIV prevalence is notable: only 0.1 per cent of cisgender controls were found to have HIV; when compared with 1.6 per cent of enrolled transgender patients, this was 16 times less than transgender patients.

The study also examined psychiatric comorbidities, an area of particular interest for the study team based out of the Centre for Addiction and Mental Health. Although no specific comorbidities were named, the study found that only 22.9 per cent of cisgender controls presented a psychiatric comorbidity, whereas 76.1 per cent of the transgender patients enrolled in the study presented a psychiatric comorbidity.

Together, these results provide the strongest support yet for the well-established hypothesis that transgender individuals face a significantly higher burden of illness — especially mental illness — when compared to their cisgender counterparts.

What causes these health conditions to be more prevalent?

The causes for this are complex, multifaceted, and misunderstood.

For one, the study found that transgender individuals are more likely to live in lower-income neighbourhoods and receive lower income, as determined by a higher prevalence of low-income markers, such as usage of the provincial drug plan.

The authors premised that this result may “increasingly contribute to the adverse health circumstances and high rates of suicide experienced by transgender individuals.” It would appear that the stigma and discrimination transgender individuals face not only contribute to marked socioeconomic disadvantages but also further work hand-in-hand to detract from their health and quality of life.

On the contrary, the study found that health care use is significantly higher across the board in the transgender patients when compared with the cisgender controls. Transgender patients use primary care, emergency, and specialist services more than cisgender controls, with a particular emphasis on the uptick of mental health emergency visits and psychiatric consultations.

This finding makes more sense when viewed as a result of the transgender community’s higher burden of disease, as opposed to a cause.

The study’s results and conclusions provide valuable feedback to clinicians who have transgender patients. For one, the paper makes it evident that it is essential for caregivers to identify a patient as transgender and then remain mindful of their unique health needs as members of the transgender community and of the inequities they face. Furthermore, particular attention must  be given to psychiatric care.

To remedy these issues, awareness and action is necessary at all levels in health care, from frontline caregivers to senior policymakers.