Direct exposure to gender identity-related discrimination and erasure among the transgender and gender independent (TGI) population are associated with healthcare underutilization, which may further exacerbate the health disparities that exist between this population and cisgender individuals in the United States (U.S.). Although the impacts of direct exposure to healthcare discrimination and erasure may have on TGI individuals are known, exposure to such harm vicariously (i.e., through observation or report) is underexplored. The present study examined the relationships among direct and vicarious gender identity-related healthcare discrimination and erasure exposure and past-year healthcare utilization. Gender identity-based mistrust in healthcare was also assessed, as a mechanism through which direct and vicarious gender identity-related healthcare discrimination and erasure predict healthcare utilization behaviors among a sample (N = 385) of TGI adults in the U.S., aged 18 to 71 recruited online. Results indicated direct lifetime and vicarious healthcare discrimination and erasure exposure significantly predicted past-year healthcare underutilization when participants anticipated encountering gender identity-related healthcare discrimination. Mediational analyses indicated that higher levels of exposure to direct lifetime and vicarious healthcare discrimination and erasure were related to higher levels of mistrust in healthcare, through which past-year underutilization was significantly related. These findings are vital to informing healthcare practice and policy initiatives aimed at ensuring the barriers that deleteriously influence the accessibility of healthcare among TGI individuals are ameliorated.

中文翻译：

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跨性别者和性别独立个体直接和间接遭受医疗保健歧视和消除：测试医疗保健不信任对利用行为的间接影响

跨性别和性别独立（TGI）人群直接遭受与性别认同相关的歧视和抹除与医疗保健利用不足有关，这可能会进一步加剧该人群与美国（US）顺性别个体之间存在的健康差距。尽管直接暴露于医疗保健歧视和抹除可能对 TGI 个人产生的影响是已知的，但间接暴露于此类伤害（即通过观察或报告）的情况尚未得到充分研究。本研究探讨了直接和间接性别认同相关的医疗保健歧视和删除暴露与过去一年的医疗保健利用之间的关系。还评估了基于性别认同的医疗保健不信任，作为一种机制，通过该机制，直接和间接的性别认同相关医疗保健歧视和消除可以预测美国 18 至 71 岁 TGI 成年人样本（N = 385）的医疗保健利用行为网上招聘。结果表明，当参与者预计会遇到与性别认同相关的医疗保健歧视时，直接终身和替代医疗保健歧视和删除暴露显着预测了过去一年的医疗保健利用不足。中介分析表明，直接终生和间接医疗保健歧视和消除的程度较高与对医疗保健的不信任程度较高有关，而过去一年的利用不足与此显着相关。这些发现对于为医疗保健实践和政策举措提供信息至关重要，这些举措旨在确保改善有害影响 TGI 个人获得医疗保健的障碍。