Faletsky Adam, Jonczyk Michael M, Guo Lifei
Division of Plastic Surgery, Lahey Hospital and Medical Center, Burlington, Mass.
Tufts University School of Medicine, Boston, Mass.
Plast Reconstr Surg Glob Open. 2022 Aug 31;10(8):e4496. doi: 10.1097/GOX.0000000000004496. eCollection 2022 Aug.
Although gender-affirming surgery is increasingly performed, few studies have examined any temporal correlation between legislations mandating transgender care and the actuation of such surgical care.
We assembled a retrospective cohort utilizing the National Inpatient Sample database from 2000 to 2018. We stratified utility trends of gender-affirming surgery based on insurance payer types and regions in a crisscrossing effort to detect any temporal or cause-effect relationship between legislations and outcomes. All regions according to the latest National Inpatient Sample categorization were examined based on the nature of their member state's legislations relating to gender-affirming care coverage. Diametrically, opposite regions were selected for further comparisons. Interrupted time series analyses were used to demonstrate any significant uptrend since implementation of relevant legislations.
In states with explicit inclusion of gender-affirming care, our interrupted time series analyses showed a significant increase in the number of patients on state-dependent insurance (Medicaid and private insurance) receiving gender-affirming surgery around the time during which state legislations began mandating care ( < 0.01) and thereafter ( < 0.01). This significance was not seen in the same regions among patients under nonstate-dependent payers (Medicare and self-pay), nor was it seen in either payer group in states without explicit inclusion of gender-affirming care. At the federal level, statistical significance was noted among Medicare recipients across all states around the time federal legislations took effect and thereafter.
Legislations mandating coverage seem highly effective in actuating surgical care of transgender patients in corresponding jurisdictions, which may provide a roadmap for further care expansion.
尽管性别肯定手术的实施越来越多，但很少有研究考察强制提供跨性别医疗服务的立法与此类手术治疗启动之间的时间相关性。
我们利用2000年至2018年的国家住院样本数据库组建了一个回顾性队列。我们根据保险支付方类型和地区对性别肯定手术的效用趋势进行分层，以交叉分析的方式检测立法与结果之间的任何时间或因果关系。根据最新的国家住院样本分类，所有地区都根据其成员国与性别肯定医疗覆盖相关的立法性质进行了检查。从完全相反的地区中选择进行进一步比较。采用中断时间序列分析来证明自相关立法实施以来的任何显著上升趋势。
在明确纳入性别肯定医疗的州，我们的中断时间序列分析显示，在州立法开始强制提供医疗服务前后（<0.01）以及此后（<0.01），接受性别肯定手术的依赖州保险（医疗补助和私人保险）患者数量显著增加。在同一地区，非依赖州支付方（医疗保险和自费）的患者中未观察到这种显著性，在未明确纳入性别肯定医疗的州的任何一个支付方组中也未观察到。在联邦层面，在联邦立法生效前后以及此后，所有州的医疗保险受益人中都注意到了统计学显著性。
强制覆盖的立法在相应司法管辖区启动跨性别患者的手术治疗方面似乎非常有效，这可能为进一步扩大医疗服务提供路线图。
