Cohort study of mortality and morbidity in transgender persons

描述(由申请人提供)：这项申请的目标是对接受激素和/或外科性别改变干预的个人的短期和长期健康结果进行纵向队列研究。变性人社区的成员和照顾变性人的医疗保健提供者对这一人群的心理和身体健康问题表示担忧；然而，美国尚未对变性人进行纵向研究。该项目包括两个截然不同的阶段。第一阶段是一项基于电子病历(EMR)的研究，评估5462名变性人的队列，他们的护理由退伍军人管理局(Veterans Administration)(全国)或Kaiser Permanente(佐治亚州和北加州)承保。我们将比较全队列和女性对男性(FTM)和男性对女性(MTF)亚队列中的发病率、患病率和死亡率估计，与年龄和健康计划匹配的男性和女性参与者样本中的相应指标进行比较。我们还将进行队列内分析，以比较不同类别的变性人参与者的健康结果(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)将描述研究登记的促进者和障碍，并确定有助于在未来的观察性研究和干预试验中招募变性人的影响点。将通过重点小组讨论(FGD)实现这一目标，并将使用定性方法分析由此产生的信息。FGDS将致力于评估三个核心问题：1)研究招生的障碍，2)研究参与的促进者，3)未来研究的招募建议。拟议的项目将由一个多学科小组执行，其中包括慢性和性传播疾病、精神障碍和性少数群体健康问题的流行病学专家。所有项目活动都将在与研究联络员协商的情况下实施，这些联络员将作为变性人社区的倡导者。这项拟议的研究很可能是迄今为止可获得的最大规模的变性人队列，也是第一个 在美国进行的这类研究。这个项目的另一个显著特点是 这将为未来使用全国范围内的数据源的全面研究奠定基础。

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.