Examining Health Comorbidities and Healthcare Utilization Disparities among Older Transgender and Cisgender Adults in the U.S.

项目摘要 美国的跨性别和性别多样性（TGD）人群经历了显著的健康差异 在整个生命过程中相对于顺性别的人。虽然广泛的基于社区的研究来自 方便的样本和一个新兴的研究机构使用人口水平的数据评估了 虽然TGD个体的医疗保健利用率很高，但这项研究的大部分集中在年轻的TGD人群上。小 存在关于老年TGD人健康的国家数据（即，55岁以上）。老年人，不分性别 身份，在发展的共病，负担医疗保健系统的风险增加。TGD老年人 与顺性别者相比， 这是因为他们一生都在承受与耻辱有关的压力。此外，像所有人一样，TGD的人 需要常规护理，并且随着年龄的增长，通常需要急性和急性后护理;然而，TGD个体也有 独特的医学性别确认需求（例如，激素或手术）和缺乏研究已经探索了 使用这些服务的方式塑造老年TGD人使用其他常规和急性护理。的 这项研究的长期目标是提高医疗质量，最终改善老年TGD患者的健康 人本研究的总体目标是全面了解合并症， 老年TGD成人的医疗保健使用。符合NOT-MD-19-001：“关于性和 少数性别（SGM）人口，“我们建议使用新的算法来识别30，000多名老年人的样本 医疗保险数据中的TGD患者，并在10年的门诊、急性和急性后 索赔和评估数据。我们还将把医疗保险数据与州一级的数据联系起来，并使用定性方法， 了解塑造老年TGD成人健康结果的多层次因素。为了实现这些目标，我们 提出以下目的：1）描述单一和共病慢性疾病的患病率和发病率 TGD医疗保险受益人之间的条件，并比较TGD和顺性别的医疗保健利用率 2）了解个人，医疗保健系统和社区因素如何影响健康， 老年TGD成人相对于老年顺性别成人的医疗保健使用;以及3）将定量 通过定性评估（通过患者和提供者访谈）个人、医疗保健系统和 社区层面的障碍和促进因素，以最佳的健康和医疗保健利用的老年TGD成人，可以 在今后的多层次干预中加以解决。这个项目是创新的，因为我们将使用数据集，方法， 和结果，以前没有被应用于了解老年人TGD的健康 人口这项工作将产生重大影响，因为它将产生新颖的，临床重要的和政策相关的 关于老年TGD成人如何照顾，因为他们变得更加严重的证据。最后，完成 这项研究将为未来改善老年人护理和健康的多层次干预奠定基础 美国的TGD人口。

PROJECT SUMMARY Transgender and gender diverse (TGD) people in the United States (US) experience significant health disparities throughout the life course relative to cisgender people. While extensive community-based research drawn from convenience samples and a burgeoning body of research using population-level data has assessed the healthcare utilization of TGD individuals, much of this research has focused on younger TGD people. Little national data exist on the health of older TGD people (i.e., 55 and older). Older adults, regardless of gender identity, are at increased risk of developing comorbidities that burden the healthcare system. TGD older adults are expected to be at even higher risk of developing multiple, concurrent health problems than cisgender people due to the stigma-related stress they experience throughout their lives. Further, like all people, TGD people require routine care and, often acute and post-acute care as they age; however, TGD individuals also have unique medical gender affirmation needs (e.g., hormones or surgery) and a dearth of research has explored the ways in which the use of these services shape older TGD people's use of other routine and acute care. The long-term goal of this research agenda is to improve healthcare quality and ultimately the health of older TGD people. The overall objective of this study is to create a comprehensive understanding of the comorbidities and healthcare use of older TGD adults. Consistent with NOT-MD-19-001: “Research on the Health of Sexual and Gender Minority (SGM) Population,” we propose to do use novel algorithms to identify a sample of 30,000+ older TGD people in Medicare data and follow their outcomes across 10 years of outpatient, acute- and post-acute claims and assessment data. We will also link Medicare data to state-level data and use qualitative methods to understand the multilevel factors that shape health outcomes for older TGD adults. To achieve these goals, we propose the following Aims: 1) To describe the prevalence and incidence of single and comorbid chronic conditions among TGD Medicare beneficiaries and to compare the healthcare utilization of TGD and cisgender beneficiaries; 2) To understand how individual, healthcare system, and community factors influence health and healthcare use of older TGD adults relative to older cisgender adults; and 3) To contextualize the quantitative findings by qualitatively assessing (via patient and provider interviews) the individual, healthcare system, and community-level barriers and facilitators to optimal health and healthcare utilization for older TGD adults that can be addressed in future multilevel interventions. This project is innovative because we will use datasets, methods, and outcomes that have not been previously applied to understanding the health of the older adult TGD population. This work will have a significant impact as it will yield novel, clinically-important, and policy-relevant evidence about how older TGD adults are cared for as they become more significantly ill. Finally, completion of this study will lay the groundwork for future multilevel interventions to improve the care of and health of the older TGD population in the US.