Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data
Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data
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DOI：
10.1089/lgbt.2016.0208
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发表时间：
2017-11-10
期刊：
影响因子：
4.8
通讯作者：
Laffan, Alison M.
中科院分区：
文献类型：
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作者：
Dragon, Christina N.;Guerino, Paul;Laffan, Alison M.
目的：关于变性人健康和福祉的数据有限。然而，使用索赔数据，我们可以很有信心地识别跨性别医疗保险受益人（TMB）。我们试图描述TMB人口和TMB和cisgender医疗保险受益人（CMB）之间的慢性疾病负担的比较，从而奠定了国家级TMB健康差距research.Methods的基础：使用先前验证的索赔算法的基础上ICD-9-CM代码有关变性和性别认同障碍，我们确定了一个队列的TMB使用医疗保险收费服务（FFS）索赔数据。然后，我们描述了人口统计学特征和慢性疾病负担的TMB（N = 7454）和CMB（N = 39,136,229）。结果：相比CMB，更大比例的TMB是年轻人（65岁以下）和黑人，虽然这些差异因权利而异。无论权利如何，TMB比CMB有更多的慢性疾病，更多的TMB被诊断患有哮喘，自闭症谱系障碍，慢性阻塞性肺病，抑郁症，肝炎，艾滋病毒，精神分裂症和物质使用障碍。TMBs也有较高的潜在致残精神健康和神经/慢性疼痛的条件下，以及肥胖和其他肝脏疾病（非肝炎），观察率相比，CMBs.Conclusion：这是第一次系统地看看慢性疾病的负担，在变性人口使用医疗FFS索赔数据。我们发现，TMB经历多种慢性疾病的比率高于CMB，无论医疗保险的权利。65岁以下的TMB显示出已经很重的慢性疾病负担，而且只会随着年龄的增长而加剧。
Purpose: Data on the health and well-being of the transgender population are limited. However, using claims data we can identify transgender Medicare beneficiaries (TMBs) with high confidence. We seek to describe the TMB population and provide comparisons of chronic disease burden between TMBs and cisgender Medicare beneficiaries (CMBs), thus laying a foundation for national level TMB health disparity research.Methods: Using a previously validated claims algorithm based on ICD-9-CM codes relating to transsexualism and gender identity disorder, we identified a cohort of TMBs using Medicare Fee-for-Service (FFS) claims data. We then describe the demographic characteristics and chronic disease burden of TMBs (N = 7454) and CMBs (N = 39,136,229).Results: Compared to CMBs, a greater observed proportion of TMBs are young (under age 65) and Black, although these differences vary by entitlement. Regardless of entitlement, TMBs have more chronic conditions than CMBs, and more TMBs have been diagnosed with asthma, autism spectrum disorder, chronic obstructive pulmonary disease, depression, hepatitis, HIV, schizophrenia, and substance use disorders. TMBs also have higher observed rates of potentially disabling mental health and neurological/chronic pain conditions, as well as obesity and other liver conditions (nonhepatitis), compared to CMBs.Conclusion: This is the first systematic look at chronic disease burden in the transgender population using Medicare FFS claims data. We found that TMBs experience multiple chronic conditions at higher rates than CMBs, regardless of Medicare entitlement. TMBs under age 65 show an already heavy chronic disease burden which will only be exacerbated with age.