Identifying Gender Minority Patients' Health and Health Care Needs

03/05/2018

Cambridge Health Alliance researchers find that gender minority Medicare beneficiaries used more mental health care and had more hospitalizations and ER visits than non-gender minority beneficiaries

CAMBRIDGE, Mass. — A new study by Cambridge Health Alliance/Harvard Medical School’s Health Equity Research Lab and collaborators finds that gender minority (transgender and gender non-binary) Medicare beneficiaries had more mental health care, hospitalizations and emergency department visits than other beneficiaries from 2009-2014. The study, published today in the March issue of Health Affairs, is the first to describe these health care use outcomes for gender minority beneficiaries in Medicare. Lead author Ana Progovac, PhD, a senior scientist at the Health Equity Research Lab and an instructor in psychiatry at Harvard Medical School, will present key findings during a Health Affairs press briefing in Washington, DC, on March 6, 2018.

The study adds to a limited but growing research literature measuring health and healthcare needs for transgender and gender non-binary people. Targeted surveys have shown that gender minority individuals face higher health and social burdens, including higher rates of homelessness and unemployment, physical and sexual abuse, discrimination, and worse health and mental health status. Gender minority people often report delaying needed medical care due to fear of discrimination.

An estimated one million people (and likely more) in the U.S. do not identify with their sex assigned at birth, yet have been largely “invisible” in health care research because gender identity is rarely measured in nationally representative health survey and administrative datasets, or electronic health record systems. Gender identity is not currently measured in Medicare, but the authors used a Centers for Medicare and Medicaid services algorithm to identify beneficiaries likely to be gender minorities.

In this study, gender minority people were more likely to have mental health conditions and to be low-income (eligible for Medicaid) than non-gender minority beneficiaries. Some of the largest differences for health care use were found for outpatient mental health visits and emergency department use. Adjusting for age and presence of mental health conditions, annual outpatient mental health visits were about 178 percent higher in gender minorities vs. non-gender minorities in the group over aged 65, and 63 percent higher in the disabled beneficiary group. After adjusting for age and mental and physical comorbidities, annual emergency department use rates were about 35 percent higher for gender minorities in the group over 65, and 15 percent higher for the disabled group. Preventive care visits were mostly similar by gender identity.

"These findings point to a need for more research and policy efforts to improve the identification of gender identity across data sources," said Dr. Progovac. "Strategies must be developed to improve the health for gender minority individuals who have been largely 'invisible' in national health research."


“Identifying Gender Minority Patients’ Health and Health Care Needs in Administrative Claims Data.”
Ana M. Progovac, Benjamin Lê Cook, Alex McDowell, Timothy B. Creedon, Ye Wang, Brian Mullin, Maria Jose Sanchez and Mark A. Schuster. Health Affairs, March 5, 2018.