Using data from the latest census, York University researchers from the Faculty of Health found Canadians who identify as gender diverse experience disability at rates much higher than their cis counterparts. In particular, non-binary individuals consistently had the highest levels of disabilities, followed by binary-transgender individuals.
Research lead Associate Professor Antony Chum says the findings the first of their kind, as Canada is the first country to collect census information on gender identity point to an urgent need for policymakers and the health-care system to better support trans and non-binary individuals.
"Canada just started collecting gender-identity data in the national census in 2021 and that gave us a rare opportunity to explore experiences of these groups at a national scale that's never been done before," says Chum, Canada Research Chair in Population Health Data Science. "Things like discrimination, being misgendered, having to explain their gender to other people, and feeling invisible in health-care settings are common experiences for gender non-conforming people. It's a lot to carry, and it can take a toll over time, especially on mental health."
Other York researchers involved in the study include postdoctoral fellows and researchers at the Population Health Data Science Lab at York, Yihong Bai, Peiya Cao, and Kristine Ienciu.
Because of Canada's unique data collection, the study looked at a large sample of gender-diverse individuals 110,000 were identified in the census the researchers were able to dig into results for different groups of gender-diverse individuals, revealing specific vulnerabilities, says Cao. "Most studies are looking at smaller samples, so they cannot desegregate the data in that way."
They used the term activity limitations in the study rather than disability to reflect updated language by the World Health Organization. The limitations they were specifically looked at were difficulty seeing, difficulty hearing, challenges with mobility such as walking, cognitive activity limitations (previously called cognitive disabilities), mental health limitations, and "other" which encompasses limitations lasting longer than six months.
Among the findings of the study recently published in Preventative Medicine, "Gender Identity and Activity Limitations: A National Study on Transgender and Non-Binary Canadians":
Non-binary individuals assigned female at birth (AFAB) reported the highest level of activity limitations, with more close to 75 per cent reporting at least one, followed by more than 60 per cent of non-binary individuals assigned male at birth (AMAB), nearly 45 per cent of transgender men, and close to 35 per cent of transgender women reporting limitations. Cisgender men and cisgender women had the lowest reported limitations at around 20 per cent.
Of all the categories the researchers looked at, mental limitations showed the largest disparity, with nearly 40 per cent of non-binary AFAB individuals affected, compared to less than five per cent of cisgender men.
"These findings were persistent across household income level and age," says Bai. "We thought there would be a disparity, but we didn't imagine the disparity was that large before we saw the results."
These findings highlight significant disparities in activity limitations across gender identities, say the researchers, and the need for better policies and support systems, emphasizing inclusive health-care training and environments.
"When we look at the clinical literature, it shows it's important for health care to be inclusive and supportive of these groups. So this could mean training doctors and nurses to better understand their unique challenges, making sure medical forms and environments are not assuming binary gender, providing easier access to things like gender-affirming care, and addressing mental health issues can help," says Chum.
