Health Care Satisfaction in Relation to Gender Identity: Behavioral Risk Factor Surveillance Survey, 20 States (2014-2018)

UMMS Affiliation

Department of Population and Quantitative Health Sciences; Graduate School of Biomedical Sciences

Publication Date


Document Type



Epidemiology | Gender and Sexuality | Health Services Administration | Health Services Research | Mental and Social Health | Psychiatry and Psychology


BACKGROUND: Health care satisfaction is a key component of patient-centered care. Prior research on transgender populations has been based on convenience samples, and/or grouped all gender minorities into a single category.

OBJECTIVE: The objective of this study was to quantify differences in health care satisfaction among transgender men, transgender women, gender nonconforming, and cisgender adults in a diverse multistate sample.

RESEARCH DESIGN: Cross-sectional analysis of 2014-2018 Behavioral Risk Factor Surveillance System data from 20 states, using multivariable logistic models.

SUBJECTS: We identified 167,468 transgender men, transgender women, gender-nonconforming people, cisgender women, and cisgender men and compared past year health care satisfaction across these groups.

RESULTS: Transgender men and women had the highest prevalence of being "not at all satisfied" with the health care they received (14.6% and 8.6%, respectively), and gender-nonconforming people had the lowest prevalence of being "very satisfied" with their health care (55.7%). After adjustment for sociodemographic characteristics, transgender men were more likely to report being "not at all satisfied" with health care than cisgender men (odds ratio: 4.45, 95% confidence interval: 1.72-11.5) and cisgender women (odds ratio: 3.40, 95% confidence interval: 1.31-8.80).

CONCLUSIONS: Findings indicate that transgender and gender-nonconforming adults report considerably less health care satisfaction relative to their cisgender peers. Interventions to address factors driving these differences are needed.


transgender, gender nonconforming, health care satisfaction, UMCCTS funding

DOI of Published Version



Ferrucci KA, Walubita T, Beccia AL, Ding EY, Jesdale BM, Lapane KL, Streed CG Jr. Health Care Satisfaction in Relation to Gender Identity: Behavioral Risk Factor Surveillance Survey, 20 States (2014-2018). Med Care. 2021 Jan 22. doi: 10.1097/MLR.0000000000001508. Epub ahead of print. PMID: 33492048. Link to article on publisher's site

Journal/Book/Conference Title

Medical care

PubMed ID


Related Resources

Link to Article in PubMed