Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017
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...
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2023.1102348/full |
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| author | Jaclyn M. W. Hughto Jaclyn M. W. Hughto Jaclyn M. W. Hughto Hiren Varma Hiren Varma Gray Babbs Gray Babbs Kim Yee Ash Alpert Ash Alpert Ash Alpert Landon Hughes Landon Hughes Jacqueline Ellison Jacqueline Ellison Jae Downing Theresa I. Shireman Theresa I. Shireman |
| author_facet | Jaclyn M. W. Hughto Jaclyn M. W. Hughto Jaclyn M. W. Hughto Hiren Varma Hiren Varma Gray Babbs Gray Babbs Kim Yee Ash Alpert Ash Alpert Ash Alpert Landon Hughes Landon Hughes Jacqueline Ellison Jacqueline Ellison Jae Downing Theresa I. Shireman Theresa I. Shireman |
| author_sort | Jaclyn M. W. Hughto |
| collection | DOAJ |
| description | 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. |
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| last_indexed | 2024-04-10T04:05:56Z |
| publishDate | 2023-03-01 |
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| spelling | doaj.art-6f0cb1dabb304e6d830a50736b2296932023-03-13T05:50:42ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-03-011410.3389/fendo.2023.11023481102348Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017Jaclyn M. W. Hughto0Jaclyn M. W. Hughto1Jaclyn M. W. Hughto2Hiren Varma3Hiren Varma4Gray Babbs5Gray Babbs6Kim Yee7Ash Alpert8Ash Alpert9Ash Alpert10Landon Hughes11Landon Hughes12Jacqueline Ellison13Jacqueline Ellison14Jae Downing15Theresa I. Shireman16Theresa I. Shireman17Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, United StatesDepartments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, United StatesThe Fenway Institute, Fenway Health, Boston, MA, United StatesCenter for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United StatesDepartment of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United StatesCenter for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United StatesDepartment of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United StatesOregon Health & Science University - Portland State University School of Public Health, Portland, OR, United StatesCenter for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United StatesDepartment of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United StatesDepartment of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United StatesInstitute for Social Research, University of Michigan, Ann Arbor, MI, United States0Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States1Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh Department of Medicine, Pittsburgh, PA, United StatesOregon Health & Science University - Portland State University School of Public Health, Portland, OR, United StatesCenter for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United StatesDepartment of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United StatesIntroductionThe 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.https://www.frontiersin.org/articles/10.3389/fendo.2023.1102348/fulltransgenderMedicareagingolder adultsinsurance claimschronic conditions |
| spellingShingle | Jaclyn M. W. Hughto Jaclyn M. W. Hughto Jaclyn M. W. Hughto Hiren Varma Hiren Varma Gray Babbs Gray Babbs Kim Yee Ash Alpert Ash Alpert Ash Alpert Landon Hughes Landon Hughes Jacqueline Ellison Jacqueline Ellison Jae Downing Theresa I. Shireman Theresa I. Shireman Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017 Frontiers in Endocrinology transgender Medicare aging older adults insurance claims chronic conditions |
| title | Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017 |
| title_full | Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017 |
| title_fullStr | Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017 |
| title_full_unstemmed | Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017 |
| title_short | Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017 |
| title_sort | disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries 2008 2017 |
| topic | transgender Medicare aging older adults insurance claims chronic conditions |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2023.1102348/full |
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