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      Transgender Population Size in the United States: a Meta-Regression of Population-Based Probability Samples

      review-article
      , PhD , , PhD
      American Journal of Public Health
      American Public Health Association

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          Abstract

          Background. Transgender individuals have a gender identity that differs from the sex they were assigned at birth. The population size of transgender individuals in the United States is not well-known, in part because official records, including the US Census, do not include data on gender identity. Population surveys today more often collect transgender-inclusive gender-identity data, and secular trends in culture and the media have created a somewhat more favorable environment for transgender people.

          Objectives. To estimate the current population size of transgender individuals in the United States and evaluate any trend over time.

          Search methods. In June and July 2016, we searched PubMed, Cumulative Index to Nursing and Allied Health Literature, and Web of Science for national surveys, as well as “gray” literature, through an Internet search. We limited the search to 2006 through 2016.

          Selection criteria. We selected population-based surveys that used probability sampling and included self-reported transgender-identity data.

          Data collection and analysis. We used random-effects meta-analysis to pool eligible surveys and used meta-regression to address our hypothesis that the transgender population size estimate would increase over time. We used subsample and leave-one-out analysis to assess for bias.

          Main results. Our meta-regression model, based on 12 surveys covering 2007 to 2015, explained 62.5% of model heterogeneity, with a significant effect for each unit increase in survey year ( F = 17.122; df = 1,10; b = 0.026%; P = .002). Extrapolating these results to 2016 suggested a current US population size of 390 adults per 100 000, or almost 1 million adults nationally. This estimate may be more indicative for younger adults, who represented more than 50% of the respondents in our analysis.

          Authors’ conclusions. Future national surveys are likely to observe higher numbers of transgender people. The large variety in questions used to ask about transgender identity may account for residual heterogeneity in our models.

          Public health implications. Under- or nonrepresentation of transgender individuals in population surveys is a barrier to understanding social determinants and health disparities faced by this population. We recommend using standardized questions to identify respondents with transgender and nonbinary gender identities, which will allow a more accurate population size estimate.

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          Most cited references21

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          Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7

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            Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions.

            Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma.
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              Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations

              Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.
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                Author and article information

                Journal
                Am J Public Health
                Am J Public Health
                ajph
                American Journal of Public Health
                American Public Health Association
                0090-0036
                1541-0048
                February 2017
                February 2017
                February 2017
                : 107
                : 2
                : e1-e8
                Affiliations
                At the time of the study, Esther L. Meerwijk was with the Department of Family Health Care Nursing, University of California, San Francisco. Jae M. Sevelius is with the Department of Medicine, University of California, San Francisco.
                Author notes
                Correspondence should be sent to Esther Meerwijk, VA Health Services Research and Design, Center for Innovation to Implementation, VA Palo Alto Health Care System, Willow Rd 795, Menlo Park, CA 94025 (e-mail: esther.meerwijk@ 123456va.gov ). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.

                CONTRIBUTORS

                E. Meerwijk designed the study, takes responsibility for integrity of data collection and accuracy of data analysis, and drafted the article. Both authors contributed to interpretation of the data, critically revised the article, and approve this final version.

                Peer Reviewed

                Article
                PMC5227946 PMC5227946 5227946 201617418
                10.2105/AJPH.2016.303578
                5227946
                28075632
                66b4548a-ba98-4f2c-81e6-1ee4b42087e8
                © American Public Health Association 2017
                History
                : 13 November 2016
                Page count
                Pages: 8
                Categories
                Epidemiology
                Gender
                Lesbian/Gay/Bisexual/Transgender Persons
                AJPH Transgender Health
                Transgender

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