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

项目总结 美国跨性别者和不同性别(TGD)人群的健康差异显著 在整个生命过程中，相对于顺性人。虽然广泛的基于社区的研究来自于 便利样本和使用人口水平数据的新兴研究机构评估了 关于TGD患者的医疗保健利用情况，这项研究的大部分内容都集中在较年轻的TGD人群。一点儿 有关于TGD老年人(即55岁及以上)健康状况的国家数据。老年人，不分性别 身份，患上并存疾病的风险增加，给医疗保健系统带来负担。TGD老年人 预计比顺性人更有可能出现多种同时存在的健康问题 由于他们一生中所经历的与耻辱相关的压力。此外，像所有人一样，TGD人 需要常规护理，随着年龄的增长，通常是急性和急性后护理；然而，TGD患者也有 独特的医学性别肯定需求(例如，激素或手术)，但缺乏研究探索 这些服务的使用方式影响了TGD老年人对其他常规和急性护理的使用。这个 这项研究议程的长期目标是改善医疗质量，并最终改善老年TGD的健康 人民。这项研究的总体目标是建立一个全面的了解并存和 老年TGD成年人的医疗保健使用。与NOT-MD-19-001一致：“性和性行为健康研究” 性别少数(SGM)人口，我们建议确实使用新的算法来识别30,000多名老年人的样本 TGD人群的医疗保险数据，并跟踪他们在门诊、急性期和急性后10年的结果 索赔和评估数据。我们还将将医疗保险数据与州一级数据联系起来，并使用定性方法来 了解影响老年TGD患者健康结果的多层次因素。为了实现这些目标，我们 提出以下目标：1)描述单项和并存慢性疾病的患病率和发病率 TGD医疗保险受益人的状况以及TGD和cissex的医疗利用情况比较 受益者；2)了解个人、医疗保健系统和社区因素如何影响健康和 老年TGD成年人相对于老年顺性成年人的医疗保健使用；以及3)将量化的 通过(通过患者和提供者访谈)定性评估个人、医疗保健系统和 社区层面的障碍和促进者，以优化TGD老年人的健康和医疗保健利用， 将在今后的多层次干预中加以解决。该项目具有创新性，因为我们将使用数据集、方法、 以及以前没有被应用于了解老年人TGD健康的结果 人口。这项工作将产生重大影响，因为它将产生新颖的、临床上重要的和与政策相关的 关于TGD老年人病情加重时如何得到照顾的证据。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.