Prevalence of diagnosed eating disorders in US transgender adults and youth in insurance claims

Abstract

Objective We estimated the prevalence of diagnosed eating disorders, overall and by select demographics, among commercially insured individuals identified as transgender in a national claims database. Methods From the 2018 IBM® MarketScan® Commercial Database, there were 10,415 people identifiable as transgender based on International Classification of Disease (ICD‐10) codes and procedure codes, specific to gender‐affirming care, from inpatient and outpatient claims. Eating disorders were identified from ICD‐10 codes and included anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified, avoidant restrictive feeding and intake disorder, and other specified feeding and eating disorders. We estimated the prevalence of specific eating disorders diagnoses by selecting patient characteristics. Results Of individuals receiving some form of gender‐affirming care, 2.43% (95% confidence interval: 2.14%–2.74%) were diagnosed with an eating disorder: 0.84% anorexia nervosa, 0.36% bulimia nervosa, 0.36% binge eating disorder, 0.15% avoidant restrictive feeding and intake disorder, 0.41% other specified feeding and eating disorders, and 1.37% with an unspecified eating disorder. Among transgender‐identifiable patients aged 12–15 years, 5.60% had an eating disorder diagnosis, whereas 0.52% had an eating disorder diagnosis in patients aged 45–64 years. Discussion In patients identifiable as transgender, with receipt of gender‐affirming care, the prevalence of diagnosed eating disorders was low compared to extant self‐reported data for eating disorder diagnosis in transgender individuals. Among this population, eating disorders were highest in adolescents and young adults. Clinically verified prevalence estimates for eating disorder diagnosis in transgender people with a history of gender‐affirming care warrant further investigation. Public Significance The present study aims to provide clinically validated, contemporary prevalence estimates for diagnosed eating disorders among a medically affirmed population of transgender adults and children in the United States. We report low prevalence of having any eating disorder relative to prevalence estimates reported in prior literature without clinical validation. These findings may be explained by access to affirming care and medical care generally.

Disordered eating in transgender and gender non‐conforming youth: A comparison to community‐based and clinical samples

“…For example, insurance claims of transgender individuals suggested that about 2.4% of the overall sample, and 5.6% of youth aged 12–15 years, had a diagnosis of an ED (Ferrucci et al., 2022). This is much lower than the proportion of individuals in the current study who endorsed clinically significant EDE‐Q scores, or episodes of binge eating and suggests that either full‐threshold EDs may be undiagnosed or undetected based on the insurance claim data (Ferrucci et al., 2022) and/or that the elevated scores in the current study may represent disordered eating thoughts and behaviours that do not meet full‐threshold criteria for an ED. Moreover, self‐reporting may overestimate the prevalence of some disordered eating behaviours (e.g., binge eating).…”

“…Indeed, a recent study of diagnosed ED cases in US transgender adults and youth within insurance claims suggested relatively lower rates of ED cases in transgender people than studies based on questionnaires have previously identified. For example, insurance claims of transgender individuals suggested that about 2.4% of the overall sample, and 5.6% of youth aged 12–15 years, had a diagnosis of an ED (Ferrucci et al., 2022). This is much lower than the proportion of individuals in the current study who endorsed clinically significant EDE‐Q scores, or episodes of binge eating and suggests that either full‐threshold EDs may be undiagnosed or undetected based on the insurance claim data (Ferrucci et al., 2022) and/or that the elevated scores in the current study may represent disordered eating thoughts and behaviours that do not meet full‐threshold criteria for an ED.…”

Eating disorders in transgender and gender diverse people: characteristics, assessment, and management

“…Prevalence estimates of eating disorders based on healthcare records are more modest. In a US insurance database [19 ▪ ], 2.4% of people seeking gender-affirming care were also diagnosed with an eating disorder: 0.84% with anorexia nervosa, 0.36% with bulimia nervosa, 0.36% with binge eating disorder, 0.15% with avoidant-restrictive food intake disorder, 0.41% with other specified feeding and eating disorders, and 1.37% with an unspecified eating disorder. The likelihood of being diagnosed was highest among adolescents and lowest among middle aged participants [19 ▪ ].…”

A Gender-Based Point of View in Pediatric Neurology

“…Regarding Eds, there is still lack of data, but as reported by Ferrucci et al, 5.6% of transgender people in a population of adolescents aged 12–15 years old received an eating disorder diagnosis [ 111 ]. This aligns with previous studies.…”