Healthcare utilization profiles, facilitating resources, and continuity of care among transgender people in Brazil: A latent class analysis
A latent class analysis of transgender people in Brazil reveals that healthcare navigation profiles, particularly engagement with primary or emergency care, are more strongly associated with continuity of care than individual facilitating resources, underscoring the critical role of structural healthcare system factors.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For many people, the path to good health is a steady, predictable journey. They have a regular doctor, a familiar clinic, and a system that guides them from a minor check-up to specialized treatment without losing their way. For transgender people, however, this journey is often fractured. Despite living in countries with universal healthcare systems designed to serve everyone, structural barriers, discrimination, and a lack of culturally competent services frequently disrupt their ability to stay connected to care. The question researchers have long asked is not just whether these individuals can find a hospital or a clinic, but whether they can maintain a stable, ongoing relationship with the health system over time. This concept, known as continuity of care, is the difference between seeing a doctor once in a crisis and having a trusted provider who knows your history and supports your long-term well-being. Understanding how transgender people navigate these complex systems is essential for building a healthcare environment that truly works for them.
In a recent study focused on the coastal region of São Paulo state in Brazil, a team of researchers set out to map exactly how transgender people move through the healthcare system. They wanted to move beyond looking at isolated factors like income or age and instead look at the patterns of behavior that define how people seek help. The researchers surveyed 199 transgender adults living in nine different municipalities, asking them where they usually go when they are sick or need medical attention. They also asked if they had a regular place or professional they returned to, which serves as a measure of continuity. To make sense of the complex mix of answers, the team used a statistical method that groups people based on their shared behaviors, creating distinct "profiles" of how they navigate care.
The analysis revealed three clear patterns of behavior. The first group consisted of people who did not seek medical help at all when they were ill. The second group relied primarily on primary care, which in Brazil is the first point of contact in the public health system, often provided by local community clinics. The third group turned mostly to emergency care services, such as urgent care centers or hospital emergency rooms, for their medical needs. When the researchers compared these groups, a striking picture emerged. People who fell into the primary care or emergency care profiles were significantly more likely to report having a consistent relationship with a healthcare provider than those who did not seek help at all. In fact, those using primary care were nearly eight times more likely to have continuity of care, while those using emergency services were nearly six times more likely, compared to the non-seeking group.
Perhaps the most surprising finding was what did not matter as much as one might expect. The study tested whether individual resources, such as having a steady income, being part of a community support network, or participating in health-promotion groups, helped predict who would have continuity of care. After accounting for the navigation profiles, these individual factors showed no strong link to whether a person had a regular doctor. This suggests that the ability to stay connected to care is less about a person's personal resources or social connections and more about the structural pathways available to them. The system itself, and the specific entry points it offers, appears to be the deciding factor.
The researchers also looked at whether income played a different role depending on which profile a person belonged to. They found that for those who did not seek help, income seemed to have a slight influence, but for those already engaged with primary or emergency care, income made little difference to their continuity. This hints that once a person is integrated into a specific care pathway, the stability of that connection may buffer them against some of the economic hardships that usually disrupt healthcare access. However, the study authors caution that because the data was collected at a single point in time, they cannot prove that one thing caused the other. They also note that their sample was not a random selection of the entire population, so the results describe the experiences of the people surveyed rather than every transgender person in Brazil.
The study concludes that improving healthcare for transgender people requires looking at the system as a whole rather than just trying to fix individual barriers. The fact that reliance on emergency services, while better than no care at all, still represents a fragmented approach highlights a gap in the system. The researchers suggest that strengthening primary care and ensuring it is inclusive and responsive is a critical step. By creating stable, welcoming entry points into the health system, policymakers can help transgender people move from crisis-driven visits to sustained, long-term relationships with their doctors. Ultimately, the study indicates that continuity of care is not just a personal achievement but a reflection of how well a healthcare system is organized to include and support its most vulnerable populations.
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