Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017

Abstract

IntroductionThe 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.MethodsUsing 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.ResultsThe 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.DiscussionThese 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.

Characterizing Disparities in the HIV Care Continuum among Transgender and Cisgender Medicare Beneficiaries

“…We adapted prior algorithms [5,26,[29][30][31] and HIV quality care guidelines [33,34] to identify a large sample of TGD and cisgender Medicare beneficiaries with HIV and examined within-and between-group differences in HIV Care Continuum engagement among these populations. Our novel methods to identify Medicare beneficiaries with HIV and explore HIV Care Continuum engagement may be helpful for future researchers seeking to study HIV-related outcomes among TGD and cisgender people using claims data.…”

“…We subsequently applied a stepwise approach [31] to categorize the inferred gender of the TGD sample. As described in detail elsewhere [5], briefly, we first classified the inferred gender of TGD individuals based on the presence of claims for gender-affirming genital surgeries (e.g., "vaginal construction," "construction of penis"). Then, within the remaining These age categories were used because only 10% of the TGD sample with HIV were age 55 years and older at enrollment, and sample sizes for some TGD subgroups (i.e., TMN in the oldest age category) would be too small to report if we split the age categories at 65+.…”

“…Interventions are needed to reduce barriers to HIV care engagement for all Medicare beneficiaries to improve treatment outcomes and reduce HIV-related morbidity and mortality in the US. INTRODUCTION Transgender and gender diverse (TGD) people in the United States (US) are at heightened risk for HIV relative to cisgender (non-transgender) people, with much of the burden experienced by trans feminine people [1][2][3][4][5]. Indeed, a recent analysis of Medicare data found that trans feminine and non-binary (TFN) people had 9 and 4.5 times the probability of having HIV compared to cisgender males and cisgender females or trans masculine and non-binary (TMN) people, respectively [5].…”

“…INTRODUCTION Transgender and gender diverse (TGD) people in the United States (US) are at heightened risk for HIV relative to cisgender (non-transgender) people, with much of the burden experienced by trans feminine people [1][2][3][4][5]. Indeed, a recent analysis of Medicare data found that trans feminine and non-binary (TFN) people had 9 and 4.5 times the probability of having HIV compared to cisgender males and cisgender females or trans masculine and non-binary (TMN) people, respectively [5]. These disparities stem from multilevel sources of stigma that lead to social and economic marginalization, limited access to preventative healthcare, poor mental health, and coping behaviors that can increase the risk of HIV transmission, including injection drug use and sex work [1,[6][7][8][9].…”

“…Moreover, national survey research finds that 86% of US TGD adults are insured [24] and Medicare insures more than a quarter of people living with HIV/AIDS [5]. Because health insurance is essential to ensuring that people living with HIV can afford the care needed to reduce HIV-related morbidity and mortality [25], understanding…”