Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, United States.
Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, United States.
Front Endocrinol (Lausanne). 2023 Mar 13;14:1102348. doi: 10.3389/fendo.2023.1102348. eCollection 2023.
The objective of this research is to provide national estimates of the prevalence of health condition diagnoses among age-entitled transgender and cisgender Medicare beneficiaries. Quantification of the health burden across sex assigned at birth and gender can inform prevention, research, and allocation of funding for modifiable risk factors.
Using 2009-2017 Medicare fee-for-service data, we implemented an algorithm that leverages diagnosis, procedure, and pharmacy claims to identify age-entitled transgender Medicare beneficiaries and stratify the sample by inferred gender: trans feminine and nonbinary (TFN), trans masculine and nonbinary (TMN), and unclassified. We selected a 5% random sample of cisgender individuals for comparison. We descriptively analyzed (means and frequencies) demographic characteristics (age, race/ethnicity, US census region, months of enrollment) and used chi-square and t-tests to determine between- (transgender vs. cisgender) and within-group gender differences (e.g., TMN, TFN, unclassified) difference in demographics (p<0.05). We then used logistic regression to estimate and examine within- and between-group gender differences in the predicted probability of 25 health conditions, controlling for age, race/ethnicity, enrollment length, and census region.
The analytic sample included 9,975 transgender (TFN n=4,198; TMN n=2,762; unclassified n=3,015) and 2,961,636 cisgender (male n=1,294,690, female n=1,666,946) beneficiaries. The majority of the transgender and cisgender samples were between the ages of 65 and 69 and White, non-Hispanic. The largest proportion of transgender and cisgender beneficiaries were from the South. On average, transgender individuals had more months of enrollment than cisgender individuals. In adjusted models, aging TFN or TMN Medicare beneficiaries had the highest probability of each of the 25 health diagnoses studied relative to cisgender males or females. TFN beneficiaries had the highest burden of health diagnoses relative to all other groups.
These findings document disparities in key health condition diagnoses among transgender Medicare beneficiaries relative to cisgender individuals. Future application of these methods will enable the study of rare and anatomy-specific conditions among hard-to-reach aging transgender populations and inform interventions and policies to address documented disparities.
本研究旨在为符合条件的年龄的跨性别和 cisgender 医疗保险受益人的健康状况诊断患病率提供国家估计。按出生时的性别和性别分配量化健康负担，可以为可改变的风险因素的预防、研究和资金分配提供信息。
使用 2009-2017 年医疗保险收费服务数据，我们实施了一种算法，利用诊断、程序和药房理赔来识别符合条件的年龄的跨性别医疗保险受益人，并按推断的性别对样本进行分层：跨性别女性和非二进制（TFN）、跨性别男性和非二进制（TMN）和未分类。我们选择了 cisgender 个体的 5%随机样本进行比较。我们对人口统计学特征（年龄、种族/民族、美国人口普查区域、入组月数）进行描述性分析（平均值和频率），并使用卡方检验和 t 检验来确定跨性别与 cisgender 之间（跨性别与 cisgender）和组内性别差异（例如，TMN、TFN、未分类）在人口统计学上的差异（p<0.05）。然后，我们使用逻辑回归来估计和检查 25 种健康状况的预测概率在组内和组间的性别差异，同时控制年龄、种族/民族、入组时间和人口普查区域。
分析样本包括 9975 名跨性别者（TFN n=4198；TMN n=2762；未分类 n=3015）和 2961636 名 cisgender（男性 n=1294690，女性 n=1666946）受益人。 transgender 和 cisgender 样本的大多数年龄在 65 至 69 岁之间，并且是白人，非西班牙裔。 transgender 和 cisgender 受益人的最大比例来自南部。平均而言， transgender 个体的入组时间比 cisgender 个体长。在调整后的模型中，相对于 cisgender 男性或女性，年龄较大的 TFN 或 TMN 医疗保险受益人患 25 种研究中的每一种健康诊断的概率最高。与所有其他群体相比，TFN 受益人的健康诊断负担最高。
这些发现记录了跨性别医疗保险受益人与 cisgender 个体相比在关键健康状况诊断方面的差异。未来应用这些方法将能够研究难以接触的老龄化跨性别人群中罕见和特定解剖结构的疾病，并为解决已记录的差异提供干预和政策信息。
