医疗保险受益人性别认同的自杀率差异。
Disparities in Suicidality by Gender Identity Among Medicare Beneficiaries.
机构信息
Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts.
出版信息
Am J Prev Med. 2020 Jun;58(6):789-798. doi: 10.1016/j.amepre.2020.01.004. Epub 2020 Mar 7.
INTRODUCTION
Suicidality is higher for gender minorities than the general population, yet little is known about suicidality in disabled or older adult gender minorities.
METHODS
This study used 2009-2014 Medicare claims to identify people with gender identity-related diagnosis codes (disabled, n=6,678; older adult, n=2,018) and compared their prevalence of suicidality with a 5% random non-gender minority beneficiary sample (disabled, n=535,801; older adult, n=1,700,008). Correlates of suicidality were assessed (via chi-square) for each of the 4 participant groups separately, and then disparities within eligibility status (disabled or older adult) were assessed using logistic regression models, adjusting first for age and mental health chronic conditions and then additionally for Medicaid eligibility, race/ethnicity, or U.S. region (each separately). The primary hypotheses were that gender minority beneficiaries would have higher suicidality but that suicidality disparities would persist after adjusting for covariates. Data were analyzed between 2017 and 2019.
RESULTS
Gender minority beneficiaries had higher unadjusted suicidality than non-gender minority beneficiaries in the disabled cohort (18.5% vs 7.1%, p<0.001). Significant suicidality predictors in all 4 groups included the following: age (except in older adult gender minorities), Medicaid eligibility, depression or behavioral health conditions, avoidable hospitalizations, and violence victimization. In age- and mental health-adjusted logistic regression models, gender minorities had higher odds of suicidality than non-gender minority beneficiaries (disabled, OR=1.95, p<0.0001; older adult, OR=2.10, p<0.0001). Disparities were not attenuated after adjusting for Medicaid eligibility, race/ethnicity, or region.
CONCLUSIONS
Heightened suicidality among identified gender minority Medicare beneficiaries highlights a pressing need to identify and reduce barriers to wellness in this population.
引言
性别少数群体的自杀率高于一般人群，但人们对残疾或老年性别少数群体的自杀情况知之甚少。
方法
本研究使用 2009-2014 年医疗保险索赔数据，确定具有性别认同相关诊断代码的人群（残疾，n=6678；老年，n=2018），并将他们的自杀率与 5%的随机非性别少数受益人群样本（残疾，n=535801；老年，n=1700008）进行比较。分别评估了 4 组参与者的自杀率相关因素（通过卡方检验），然后使用逻辑回归模型评估了资格状态（残疾或老年）内的差异，首先调整年龄和精神健康慢性病，然后单独调整医疗补助资格、种族/民族或美国地区（每个因素单独调整）。主要假设是性别少数受益人群的自杀率更高，但在调整了协变量后，自杀率的差异仍然存在。数据在 2017 年至 2019 年之间进行了分析。
结果
残疾队列中，性别少数受益人群的未调整自杀率高于非性别少数受益人群（18.5%对 7.1%，p<0.001）。所有 4 组的显著自杀预测因素包括以下内容：年龄（老年性别少数群体除外）、医疗补助资格、抑郁或行为健康状况、可避免的住院治疗和暴力受害。在年龄和心理健康调整后的逻辑回归模型中，性别少数群体的自杀风险高于非性别少数群体受益人群（残疾，OR=1.95，p<0.0001；老年，OR=2.10，p<0.0001）。在调整医疗补助资格、种族/民族或地区后，差异并没有减弱。
结论
在确定的医疗保险受益的性别少数群体中，自杀率升高突出表明迫切需要识别和减少这一人群的健康障碍。
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