Table 3.
Multivariate Adjusted Risk Ratios (ARR) of Experiences with Health Insurance Denials
| Any denial (n = 11,320) | Not changing record to list correct name or gender (n = 4720) | Denied hormones for transition (n = 8612) | Denied surgery for transition (n = 4331) | |||||
|---|---|---|---|---|---|---|---|---|
| Variable | ARR (95% CI) | p value | ARR (95% CI) | p value | ARR (95% CI) | p value | ARR (95% CI) | p value |
| Insurance | ||||||||
| Private (ref) | 1.0 | 1.0 | 1.0 | 1.0 | ||||
| Medicare | 0.91 (0.77–1.08) | 0.30 | 1.16 (0.72–1.86) | 0.55 | 0.71 (0.50–1.02) | 0.03 | 0.96 (0.73–1.25) | 0.76 |
| Medicaid | 1.08 (0.98–1.18) | 0.10 | 1.50 (1.17–1.93) | 0.005 | 1.22 (1.05–1.42) | 0.02 | 1.04 (0.92–1.17) | 0.52 |
| Military-related | 1.13 (0.99–1.30) | 0.07 | 1.93 (1.33–2.80) | 0.009 | 0.63 (0.43–0.91) | 0.002 | 1.53 (1.36–1.72) | < 0.001 |
| Multiple | 1.05 (0.96–1.15) | 0.24 | 1.60 (1.21–2.12) | 0.005 | 0.88 (0.72–1.08) | 0.22 | 1.03 (0.90–1.17) | 0.62 |
| Gender | ||||||||
| Genderqueer/non-binary (ref) | 1.0 | 1.0 | 1.0 | 1.0 | ||||
| Transgender | 1.49 (1.36–1.63) | < 0.001 | 0.79 (0.62–1.02) | 0.10 | 0.92 (0.79–1.07) | 0.33 | 1.15 (1.01–1.31) | 0.02 |
| Race | ||||||||
| White (ref) | 1.0 | 1.0 | 1.0 | 1.0 | ||||
| Latino/a/Hispanic | 1.04 (0.96–1.13) | 0.33 | 1.26 (0.98–1.62) | 0.10 | 1.00 (0.85–1.19) | 0.93 | 0.93 (0.83–1.05) | 0.25 |
| Black | 1.05 (0.93–1.19) | 0.39 | 0.98 (0.69–1.40) | 0.95 | 0.91 (0.72–1.14) | 0.42 | 0.68 (0.57–0.82) | < 0.001 |
| Asian/Native Hawaiian/Pacific Islander | 0.85 (0.74–0.98) | 0.02 | 1.09 (0.70–1.70) | 0.70 | 0.83 (0.63–1.09) | 0.16 | 0.77 (0.61–0.98) | 0.02 |
| Biracial/multiracial/not listed | 0.99 (0.91–1.08) | 0.98 | 1.09 (0.82–1.45) | 0.55 | 0.92 (0.77–1.11) | 0.41 | 0.87 (0.75–1.00) | 0.04 |
| Education attainment | ||||||||
| Less than high school (ref) | 1.0 | 1.0 | 1.0 | 1.0 | ||||
| High school | 0.99 (0.78–1.24) | 0.94 | 0.63 (0.31–1.29) | 0.14 | 1.15 (0.75–1.75) | 0.54 | 0.96 (0.68–1.37) | 0.86 |
| Some college | 1.04 (0.84–1.29) | 0.67 | 0.66 (0.36–1.19) | 0.16 | 1.17 (0.77–1.77) | 0.45 | 1.03 (0.75–1.41) | 0.85 |
| Associate’s degree | 1.06 (0.86–1.31) | 0.56 | 0.63 (0.32–1.25) | 0.13 | 1.29 (0.87–1.93) | 0.25 | 1.03 (0.75–1.43) | 0.82 |
| Bachelor’s degree | 1.04 (0.84–1.29) | 0.68 | 0.57 (0.30–1.07) | 0.06 | 1.19 (0.79–1.78) | 0.42 | 0.99 (0.77–1.37) | 0.98 |
| Graduate or professional degree | 1.10 (0.89–1.35) | 0.36 | 0.67 (0.34–1.30) | 0.19 | 1.26 (0.85–1.88) | 0.28 | 0.97 (0.69–1.35) | 0.88 |
| Income | ||||||||
| No income (ref) | 1.0 | 1.0 | 1.0 | 1.0 | ||||
| Low income ($1–$10k) | 1.26 (1.09–1.46) | 0.004 | 2.18 (1.27–3.73) | 0.04 | 1.25 (0.90–1.72) | 0.21 | 1.17 (0.94–1.46) | 0.18 |
| Low-mid income ($10k–$25k) | 1.25 (1.09–1.43) | 0.003 | 2.30 (1.35–3.92) | 0.02 | 1.34 (0.98–1.83) | 0.09 | 1.21 (0.98–1.50) | 0.08 |
| Mid income ($25k–$50k) | 1.26 (1.09–1.45) | 0.002 | 2.31 (1.38–3.87) | 0.02 | 1.34 (0.98–1.84) | 0.09 | 1.24 (1.00–1.53) | 0.06 |
| Mid-high income ($50k–$100k) | 1.25 (1.08–1.44) | 0.003 | 1.83 (1.05–3.18) | 0.08 | 1.27 (0.93–1.74) | 0.15 | 1.21 (0.97–1.51) | 0.09 |
| High income ($100k +) | 1.17 (1.01–1.36) | 0.04 | 1.66 (0.93–2.97) | 0.16 | 1.16 (0.83–1.61) | 0.39 | 1.11 (0.88–1.39) | 0.38 |
| Region | ||||||||
| Northeast (ref) | 1.0 | 1.0 | 1.0 | 1.0 | ||||
| Midwest | 1.11 (1.04–1.19) | 0.001 | 1.29 (1.00–1.66) | 0.07 | 1.27 (1.12–1.46) | 0.001 | 1.40 (1.29–1.51) | < 0.001 |
| South | 1.11 (1.04–1.19) | 0.001 | 1.49 (1.16–1.91) | 0.005 | 1.41 (1.24–1.62) | < 0.001 | 1.33 (1.22–1.45) | < 0.001 |
| West | 1.06 (0.99–1.14) | 0.07 | 1.02 (0.80–1.29) | 0.86 | 0.87 (0.75–1.01) | 0.07 | 0.92 (0.84–1.01) | 0.09 |
| Age | ||||||||
| 65+ years old (ref) | 1.0 | 1.0 | 1.0 | 1.0 | ||||
| 18–25 years old | 1.49 (1.33–1.67) | < 0.001 | 3.90 (2.68–5.67) | < 0.001 | 1.87 (1.37–2.55) | 0.001 | 1.22 (1.00–1.48) | 0.046 |
| 26–44 years old | 1.43 (1.26–1.63) | < 0.001 | 3.48 (2.34–5.18) | < 0.001 | 1.53 (1.12–2.10) | 0.01 | 1.23 (1.01–1.50) | 0.03 |
| 45–64 years old | 1.32 (1.19–1.48) | < 0.001 | 2.36 (1.52–3.66) | 0.006 | 1.01 (0.72–1.43) | 0.92 | 1.09 (0.91–1.32) | 0.34 |
| Disability | 1.13 (1.07–1.20) | < 0.001 | 1.27 (1.03–1.56) | 0.03 | 1.13 (1.00–1.27) | 0.04 | 1.05 (0.96–1.14) | 0.24 |
| Any transition | 1.39 (1.15–1.67) | < 0.001 | 0.68 (0.46–1.00) | 0.10 | 0.64 (0.50–0.82) | 0.004 | 0.94 (0.78–1.14) | 0.60 |