Cohort study of mortality and morbidity in transgender persons

描述（由申请人提供）：本申请的目的是对接受激素和/或手术性别重置干预的个体进行短期和长期健康结果的纵向队列研究。跨性别群体成员和照顾跨性别者的卫生保健提供者对这一人群的精神和身体健康问题表示关切；然而，美国还没有对跨性别人群进行纵向研究。这个项目包括两个不同的阶段。第一阶段是基于电子医疗记录（EMR）的研究，评估5462名变性人，他们的护理由退伍军人管理局（全国）或凯撒医疗机构（乔治亚州和北加州）覆盖。我们将把整个队列、女性对男性（FTM）和男性对女性（MTF）亚队列的发病率、患病率和死亡率估计值与年龄和健康计划匹配的男性和女性受试者样本的相应测量值进行比较。我们还将进行队列内分析，以比较跨性别参与者不同类别的健康结果（例如，MTF与FTM或激素治疗与激素+手术）。拟议项目的第二阶段（目标3）将描述研究招募的促进因素和障碍，并确定有助于招募跨性别者进入未来观察性研究和干预试验的影响点。这一目标将通过焦点小组讨论（fgd）来实现，结果信息将使用定性方法进行分析。fgd的目标是评估三个核心问题：1)参与研究的障碍；2)参与研究的促进因素；3)招募参与未来研究的建议。拟议的项目将由一个多学科小组执行，该小组包括慢性病和性传播疾病流行病学、精神障碍和性少数群体健康问题方面的专家。所有项目活动的实施都将与研究联络员协商，他们将作为跨性别群体的倡导者。这项拟议的研究可能是迄今为止最大的跨性别人群，也是第一个

DESCRIPTION (provided by applicant): The goal of this application is to develop a longitudinal cohort study of the short- and long-term health outcomes among individuals who underwent hormonal and/or surgical gender reassignment interventions. Members of the transgender community and health care providers caring for transgender individuals express concerns about mental and physical health problems in this population; however longitudinal studies of transgender populations in the US have not been conducted. This project includes two distinct phases. The first phase is an electronic medical record (EMR) based study evaluating a cohort of 5462 transgender individuals, whose care is covered by the Veterans Administration (nationally) or by Kaiser Permanente (in Georgia and in Northern California). We will compare incidence, prevalence and mortality estimates in the full cohort and in the female-to-male (FTM) and male-to-female (MTF) sub-cohorts to the corresponding measures in the age- and health plan-matched samples of male and female enrollees. We will also perform within-cohort analyses to compare health outcomes across categories of transgender participants (e.g., MTF versus FTM or treatment with hormones versus hormones + surgery). The second phase (Aim 3) of the proposed project will describe facilitators of and barriers to research enrollment, and identify points of influence that would aid recruitment of transgender individuals into future observational studies and intervention trials. This aim will be achieved through Focus Group Discussions (FGDs), and the resulting information will be analyzed using qualitative methods. FGDs will aim to evaluate three central issues: 1) barriers to enrollment in research, 2) facilitators of research participation, and 3) recommendations for recruitment into future studies. The proposed project will be carried out by a multidisciplinary team that includes experts in epidemiology of chronic and sexually transmitted diseases, mental disorders, and sexual minority health issues. All of the project activities will be implemented in consultation wih the study liaisons who will serve as advocates for the transgender community. The proposed study will likely be the largest cohort of transgender individuals available to date, and the first study of its kind conducted in the United States. Another distinguishing feature of this project is that it will lay foundation for future full-scale studies that will use nationwide data sources.