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.
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Purpose: The study purpose was to describe trends in the size and demographics of the population of transgender Medicare beneficiaries identified using International Classification of Diseases (ICD) Clinical Modification codes over time. We also assessed how the change from ICD, Ninth Revision (ICD-9) diagnosis codes to ICD, 10th Revision (ICD-10) diagnosis codes in October 2015 has affected the ability to identify transgender beneficiaries within claims data. Methods: We used Medicare Fee-for-Service claims within the Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse from 2010 through 2016 to identify transgender beneficiaries. We linked these data to Medicare enrollment records to study demographic trends. Results: Within the Medicare program, the number of beneficiaries identified as transgender through claims data in each year has increased from 2088 beneficiaries in 2010 to 10,242 beneficiaries in 2016 (a 390% increase). The highest numbers of transgender beneficiaries were identified in 2015 and 2016, which coincide with the change to ICD-10. Similarly, more beneficiaries were identified as transgender in the 12 months after the change to ICD-10 (N = 8733) than in the 12 months before (N = 4857). Conclusion: Given that a first and critical step to better understand and eliminate health disparities and deliver culturally competent care is to identify and characterize the population of interest, this study provides an innovative view into how the change to the ICD-10 coding system affects the ability to study a transgender cohort within Medicare claims data.
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