The first release of transgender data from the California Health Interview Survey, the nation’s largest state survey, reveals the demographic characteristics of transgender adults in the state — such as population size, racial makeup and marital status — as well as sobering disparities in their health status. For example, one in five transgender adults in California has attempted suicide — a rate six times that of the state’s adult cisgender population.
The health data used in a new policy brief by The Williams Institute and the UCLA Center for Health Policy Research are among hundreds of new California Health Interview Survey estimates released today. Included are updated statistics on health insurance that show the number of uninsured Californians at record lows in 2016, primarily as a result of Medi-Cal expansion under the Affordable Care Act.
The policy brief on gender identity, which uses pooled 2015-2016 California Health Interview Survey data for greater stability, reports that 92,000 transgender adults between the ages of 18 and 70 make up 0.35 percent of California’s adult non-institutionalized population. According to the report, transgender adults have general health status, insurance and health access similar to cisgender adults, or adults who identify with their sex assigned at birth.
However, 22 percent of transgender adults have ever attempted suicide, compared to 4 percent of cisgender adults. Transgender adults are about three times more likely to have had lifetime suicidal thoughts, 34 percent to 10 percent, and nearly four times more likely to have experienced serious psychological distress in the past year, 33 percent compared to 9 percent, according to the brief. They are significantly more likely to report having a disability due to a physical, mental or emotional condition, 60 percent to 27 percent. They are more likely to delay or not get needed doctor-prescribed medicine compared to cisgender adults, 32 percent compared to 11 percent, according to the brief.
“In many ways, transgender adults in California are similar in characteristics and experiences to cisgender adults,” said Jody Herman, Scholar of Public Policy at the Williams Institute and lead author of the brief. “Yet, this study points out that there’s still much that needs to be done in California to address health disparities for the transgender population.”
Diverse survey participants
Because it reflects California’s diversity, this survey is used nationally and even internationally for its wealth of data on many under-surveyed racial, ethnic and gender minority groups. In 2016, 21,269 California households participated in the survey, and 21,444 responded in 2015. Those who were surveyed answered questions on health topics such as mental, dental and physical health issues; insurance coverage; internet usage; and baby bottle-feeding practices.
Trends and new topics
The proportion of uninsured Californians from birth to age 64 declined from 15.5 percent in 2013 — the year before the Affordable Care Act was expanded — to 9.5 percent in 2015 and to 8.5 percent, or 2.8 million people, in 2016. Residents who are undocumented make up 37.4 percent of those who are uninsured and ineligible for Medi-Cal, the public program for low-income and disabled Californians.
“More than 60 percent of the uninsured are Latino,” said Ninez Ponce, principal investigator for the survey and associate director of the center. “They have remained at the bottom of the health care pyramid.”
Although the proportion of nonelderly Latinos who were uninsured was cut almost in half, from 21.4 percent in 2013 to 12.3 percent in 2016, they remain more likely to be uninsured than members of other racial groups and account for the highest percentage of the state’s overall uninsured population, according to the survey.
Continuing uncertainties over federal funding of health programs cast a pall on gains in health insurance coverage, particularly for the one in three Californians covered by Medi-Cal. Fresno, Siskiyou, Tehama and Tulare, all rural counties, had among the highest growth in post-Affordable Care Act adult Medi-Cal enrollment — from 25.7 to 29.4 percent, according to the survey estimates. The state’s safety-net health program now covers 33.3 percent to 45 percent of the population in those counties.
“Many children and adults newly insured by the ACA’s expansion of Medi-Cal are at risk of losing health care if health program funding is cut back or allowed to languish,” said Todd Hughes, director of the California Health Interview Survey. “Rural communities will suffer significantly.”
Other noteworthy 2016 health data and trends on Californians
Transgender demographics. California’s transgender adults ages 18 to 70 are more likely to be white compared with cisgender adults, 65 percent to 39 percent, respectively, and less likely to be Latino, 13 percent to 38 percent. When asked how they currently describe themselves, 7 percent of transgender adults said male, 32 percent female, 46 percent as transgender and 15 percent as a different gender identity.
Disparities in medical care discrimination. African-American adults have the highest rate of reporting medical care discrimination due to race or ethnicity, 14.2 percent. Rates for other racial groups: whites, 2.6 percent; Asians, 5 percent; Latinos, 6.4 percent; other and multiple races, 8.7 percent. However, whites and multiple-race respondents had the highest rates of medical discrimination based on mental health, sexual orientation or gender identity, 4.5 percent and 5.1 percent, respectively.
Marriage inching down. The proportion of married adults dropped below the halfway mark in 2015 to 48.4 percent and hit 47.4 percent in 2016. The share of never-married singles is increasing gradually, reaching 27.7 percent in 2016.
Fewer married couples with children. The proportion of married adults with children has gradually declined to 22.7 percent in 2016, a 9-percentage-point drop since 2005. The proportion of married couples without children remains fairly constant at 25.8 percent. In 2016, 4.7 percent of women ages 18 to 44 said they were pregnant.
Teen facts. In 2016, 22.5 percent of teens ages 12 to 17 said they had tried an alcoholic beverage, a 14-percentage-point decline since 2003. About 1 in 10 teens have used an e-cigarette; 15.5 percent reported they have had sex; and 23 percent described themselves as obese.
Overall adult health status. Nearly four in five adult Californians report being in good/very good/excellent health. But measuring by race shows disparities: While 85.9 percent of whites reported they were in good-to-excellent health, 69.9 percent of Latinos and 77.5 percent of African-Americans said the same. Latinos make up the largest racial/ethnic group in the state, 39.2 percent, according to the state Department of Finance.
Dental health. Nearly 71 percent of adults report they have excellent/very good/good teeth, and 61 percent have dental insurance. Two percent said they don’t have their own teeth. Among all children, nearly 70 percent had a dental check within the past 6 months in 2016, a 9-percentage-point increase compared to 2013. The number who had never been to a dentist was 12.5 percent — an almost 7-percentage-point decline over the same time period.
Housing crunch. Homeownership has steadily declined statewide over the past decade, from 62 percent in 2007 to 55.2 percent in 2016, although it varies from county to county. In San Francisco County, the rate is 38.6 percent and in Los Angeles County, it is 48.7 percent. Of adult survey respondents under 30, nearly half — 48.9 percent — still live with their parents.
Six years of annual information — 2011 to 2016 — are now available to the public for free through the center’s easy-to-use web tool AskCHIS, which allows users to customize their queries.
The 2016 survey spans 16 broad topic categories, including: general health; health conditions (such as chronic conditions like diabetes, asthma, high blood pressure and obesity); mental health; dental health; health behaviors (such as diet, activity, alcohol and cigarette use, sexual behaviors); neighborhood and housing (such as social cohesion); health insurance coverage and child and adolescent health insurance; access to health care; employment (status, hours, industry and occupation); child care; respondents’ characteristics (such as race, sexual orientation, gender identity and gender expression, and citizenship).
Find 2016 California Health Interview Survey data at AskCHIS.com.