Patterns of Healthcare Access and Utilization among Nonurban Transgender and Nonbinary Patients at a Large Safety Net Health System in Colorado

Current research characterizing transgender and nonbinary (TNB) communities focuses on coastal, urban centers and inadequately recognizes intersections of geography and gender identity. This study evaluates demographics, health insurance, mental health, one-way distance to care, and types of care accessed for a cohort of nonurban TNB patients seeking care at a large, safety net health system in Denver, Colorado. Electronic medical record (EMR) data were used to identify this TNB patient cohort (n = 1,230) Characteristics of age, race/ethnicity, sex assigned at birth, gender identity, insurance, residence ZIP code, alcohol use disorder, tobacco use, marijuana use, depression, and anxiety were extracted. Chart review characterized utilization patterns among non-Denver TNB patients (n = 232). Denver TNB patients were more likely to have the following characteristics: black or Hispanic identity, marijuana use, commercial insurance, depression, anxiety; comparatively, non-Denver TNB patients were more likely to be white and have public insurance coverage. The non-Denver cohort traveled an average of 82.52 miles one-way. A majority of non-Denver patients accessed gender-affirming (99%), hormone-related (81%), primary (78%), and preventive (69%) care. A minority of these patients (23%) accessed surgical transition care. Proximity to care is one of many important factors for TNB patients seeking care. The number of non-Denver TNB traveling for healthcare likely reflects a lack of accessibility to local gender-affirming care, which should prompt nonurban medical providers to seek training that meets this need. Medical educators should improve teaching on gender-affirming healthcare, particularly for rural educational tracks.