PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts.
Department of Health Care Policy and Harvard Medical School, Boston, Massachusetts.
LGBT Health. 2019 Aug/Sep;6(6):289-296. doi: 10.1089/lgbt.2018.0238. Epub 2019 Jul 17.
The purpose of this study was to characterize the health status of privately insured gender minority individuals. We created a diagnosis-based algorithm to identify gender minority children and adults in the 2009-2015 IBM MarketScan Commercial Database. We compared the age-adjusted health status among individuals with and without gender minority-related diagnosis codes. The percentage of the privately insured population with gender minority-related diagnosis codes increased from 0.004% in 2009 to 0.026% in 2015. Age-adjusted analyses demonstrated that individuals with gender minority-related diagnosis codes were more likely to have diagnoses for mental health disorders (odds ratio [OR] = 8.5; 95% confidence interval [CI] = 8.1-9.0), substance use disorders (OR = 3.4; 95% CI = 2.9-3.9), and diabetes (OR = 1.4; 95% CI = 1.2-1.6), driven by high prevalence of these conditions among individuals younger than 18 years. Our findings highlight a markedly greater prevalence of mental health and substance use disorder diagnoses among privately insured gender minority individuals. These results establish a reference point for evaluating the impact of federal- and state-level policies that ban health insurance discrimination based on gender identity on the health and health care use of gender minority individuals.
这项研究的目的是描述私人保险的性别少数群体个体的健康状况。我们创建了一个基于诊断的算法，以识别 2009-2015 年 IBM MarketScan 商业数据库中的性别少数群体儿童和成人。我们比较了有和没有性别少数群体相关诊断代码的个体的年龄调整健康状况。有性别少数群体相关诊断代码的私人保险人群比例从 2009 年的 0.004%增加到 2015 年的 0.026%。年龄调整分析表明，有性别少数群体相关诊断代码的个体更有可能被诊断出患有心理健康障碍（优势比 [OR] = 8.5；95%置信区间 [CI] = 8.1-9.0）、物质使用障碍（OR = 3.4；95% CI = 2.9-3.9）和糖尿病（OR = 1.4；95% CI = 1.2-1.6），这主要是因为 18 岁以下个体的这些疾病患病率较高。我们的发现强调了私人保险的性别少数群体个体中精神健康和物质使用障碍诊断的明显更高的患病率。这些结果为评估基于性别认同的健康保险歧视禁令的联邦和州政策对性别少数群体个体的健康和医疗保健使用的影响提供了参考点。
