2467 - Transgender and Non-Binary Disparities: Discrimination Impact on Health-Related Quality of Life - All of Us Cancer Survivor Study
Presenter(s)
D. Sabater Minarim1,2, K. Lew3, S. Rajan4, K. M. Morgan1,2, S. R. Chintala1,2, M. Banegas1,2, B. S. Rose1,2, and P. Riviere5; 1Department of Radiation Medicine and Applied Sciences, UC San Diego Health, San Diego, CA, 2UCSD Center for Health Equity, Education, and Research, San Diego, CA, 3University of California San Diego, School of Medicine, San Diego, CA, 4UCSD School of Public Health, San Diego, CA, 5University of Washington Department of Radiation Oncology, Seattle, WA
Purpose/Objective(s): Sexual and gender minorities, including transgender, gender-nonconforming, and nonbinary (TGNCNB) individuals, remain underrepresented in cancer survivorship research. Currently there is limited information about TGNCNB cancer survivors’ quality of life and supportive care outcomes. The TGNCNB community often experiences unique challenges when navigating healthcare, specifically within the quality of care and accessibility. This study aims to address the gap in understanding the impact of perceived healthcare discrimination and self-reported health status on TGNCNB individuals with cancer.
Materials/Methods: This is a cross-sectional analysis using data from the 'All of Us' research program. We included participants who reported a cancer diagnosis in the All of Us Personal and Family History questionnaire and identified TGNCNB participants using the Basics survey. We performed propensity score matching using logistic regression to balance TGNCNB and Cisgender individuals (1:5) based on age, education, income, race, insurance, and cancer site. Healthcare discrimination and overall health was assessed using the Discrimination in Medical Settings Scale and Overall Health survey. Multivariable logistic regression models were used, adjusting for demographic and socioeconomic characteristics.
Results:
Out of 1482 participants with a reported cancer diagnosis, 248 (17%) identified as TGNCNB. Their mean (SD) age was 56 (17) years, with 72% identifying as White and 28% as Black, Indigenous, or People of Color (BIPOC). TGNCNB participants showed the highest rate of overall discrimination (63%) versus women (54%) and men (34%) (p<0.001).TGNCNB participants were more likely to report feeling unheard by providers (56%), treating them with less respect (35%), assuming they were not intelligent (35%), and providers acting afraid (9%). In adjusted models, TGNCNB individuals were associated with an increased odds of experiencing discrimination (OR: 2.03, 95% CI: 1.53–2.70, p<0.01), and experiencing discrimination had the largest impact on poor health (OR: 3.05, 95% CI: 2.46–3.79, p<0.01).Conclusion: TGNCNB cancer survivors frequently report barriers to accessing competent and affirming care. To address this, cancer care providers should create inclusive clinical environments and actively acknowledge and respect patient identities. By examining the link between discrimination and health outcomes, this study underscores persistent healthcare inequities and emphasizes future research and policy efforts aimed at advancing equitable cancer care for TGNCNB individuals.