美国保险索赔中诊断为进食障碍的跨性别成年人和青少年的患病率。
Prevalence of diagnosed eating disorders in US transgender adults and youth in insurance claims.
机构信息
Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
出版信息
Int J Eat Disord. 2022 Jun;55(6):801-809. doi: 10.1002/eat.23729. Epub 2022 May 7.
OBJECTIVE
We estimated the prevalence of diagnosed eating disorders, overall and by select demographics, among commercially insured individuals identified as transgender in a national claims database.
METHODS
From the 2018 IBM® MarketScan® Commercial Database, there were 10,415 people identifiable as transgender based on International Classification of Disease (ICD-10) codes and procedure codes, specific to gender-affirming care, from inpatient and outpatient claims. Eating disorders were identified from ICD-10 codes and included anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified, avoidant restrictive feeding and intake disorder, and other specified feeding and eating disorders. We estimated the prevalence of specific eating disorders diagnoses by selecting patient characteristics.
RESULTS
Of individuals receiving some form of gender-affirming care, 2.43% (95% confidence interval: 2.14%-2.74%) were diagnosed with an eating disorder: 0.84% anorexia nervosa, 0.36% bulimia nervosa, 0.36% binge eating disorder, 0.15% avoidant restrictive feeding and intake disorder, 0.41% other specified feeding and eating disorders, and 1.37% with an unspecified eating disorder. Among transgender-identifiable patients aged 12-15 years, 5.60% had an eating disorder diagnosis, whereas 0.52% had an eating disorder diagnosis in patients aged 45-64 years.
DISCUSSION
In patients identifiable as transgender, with receipt of gender-affirming care, the prevalence of diagnosed eating disorders was low compared to extant self-reported data for eating disorder diagnosis in transgender individuals. Among this population, eating disorders were highest in adolescents and young adults. Clinically verified prevalence estimates for eating disorder diagnosis in transgender people with a history of gender-affirming care warrant further investigation.
PUBLIC SIGNIFICANCE
The present study aims to provide clinically validated, contemporary prevalence estimates for diagnosed eating disorders among a medically affirmed population of transgender adults and children in the United States. We report low prevalence of having any eating disorder relative to prevalence estimates reported in prior literature without clinical validation. These findings may be explained by access to affirming care and medical care generally.
目的
我们根据国际疾病分类（ICD-10）代码和特定于性别肯定护理的程序代码，从 2018 年 IBM® MarketScan®商业数据库中确定了 10415 名可识别为跨性别的人，在全国索赔数据库中对这些人进行了商业保险，以评估已确诊的饮食障碍的总体患病率和特定人口统计学因素。
方法
从 2018 年 IBM® MarketScan®商业数据库中，根据国际疾病分类（ICD-10）代码和特定于性别肯定护理的程序代码，从住院和门诊索赔中确定了 10415 名可识别为跨性别的人。饮食障碍是通过 ICD-10 代码确定的，包括神经性厌食症、神经性贪食症、暴食症、未特定的饮食障碍、回避限制喂养和摄入障碍以及其他特定的喂养和饮食障碍。我们通过选择患者特征来估计特定饮食障碍诊断的患病率。
结果
在接受某种形式的性别肯定护理的人中，有 2.43%（95%置信区间：2.14%-2.74%）被诊断患有饮食障碍：0.84%神经性厌食症、0.36%神经性贪食症、0.36%暴食症、0.15%回避限制喂养和摄入障碍、0.41%其他特定的喂养和饮食障碍以及 1.37%未特定的饮食障碍。在 12-15 岁的可识别跨性别患者中，有 5.60%的人被诊断出患有饮食障碍，而在 45-64 岁的患者中，有 0.52%的人被诊断出患有饮食障碍。
讨论
在接受性别肯定护理的可识别跨性别患者中，与现有的关于跨性别个体饮食障碍诊断的自我报告数据相比，已确诊饮食障碍的患病率较低。在这一人群中，青少年和年轻人的饮食障碍发生率最高。有性别肯定护理史的跨性别人群中，经临床验证的饮食障碍诊断患病率需要进一步调查。
意义
本研究旨在为美国接受医学确认的跨性别成年人和儿童群体中已确诊的饮食障碍提供具有临床验证的、当代患病率估计。我们报告的任何饮食障碍的患病率相对较低，与没有临床验证的文献中报告的患病率估计值相比。这些发现可能可以通过获得肯定的护理和一般医疗护理来解释。
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