Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017

INTRODUCTION

The objective of this research is to provide national estimates of the prevalence of health condition diagnoses among age-entitled transgender and cisgender Medicare beneficiaries. Quantification of the health burden across sex assigned at birth and gender can inform prevention, research, and allocation of funding for modifiable risk factors.

METHODS

Using 2009-2017 Medicare fee-for-service data, we implemented an algorithm that leverages diagnosis, procedure, and pharmacy claims to identify age-entitled transgender Medicare beneficiaries and stratify the sample by inferred gender: trans feminine and nonbinary (TFN), trans masculine and nonbinary (TMN), and unclassified. We selected a 5% random sample of cisgender individuals for comparison. We descriptively analyzed (means and frequencies) demographic characteristics (age, race/ethnicity, US census region, months of enrollment) and used chi-square and t-tests to determine between- (transgender vs. cisgender) and within-group gender differences (e.g., TMN, TFN, unclassified) difference in demographics (p<0.05). We then used logistic regression to estimate and examine within- and between-group gender differences in the predicted probability of 25 health conditions, controlling for age, race/ethnicity, enrollment length, and census region.

RESULTS

The analytic sample included 9,975 transgender (TFN n=4,198; TMN n=2,762; unclassified n=3,015) and 2,961,636 cisgender (male n=1,294,690, female n=1,666,946) beneficiaries. The majority of the transgender and cisgender samples were between the ages of 65 and 69 and White, non-Hispanic. The largest proportion of transgender and cisgender beneficiaries were from the South. On average, transgender individuals had more months of enrollment than cisgender individuals. In adjusted models, aging TFN or TMN Medicare beneficiaries had the highest probability of each of the 25 health diagnoses studied relative to cisgender males or females. TFN beneficiaries had the highest burden of health diagnoses relative to all other groups.

DISCUSSION

These findings document disparities in key health condition diagnoses among transgender Medicare beneficiaries relative to cisgender individuals. Future application of these methods will enable the study of rare and anatomy-specific conditions among hard-to-reach aging transgender populations and inform interventions and policies to address documented disparities.

Paleobiological reconstructions of articular function require all six degrees of freedom

Paleobiologists typically exclude impossible joint poses from reconstructions of extinct animals by estimating the rotational range of motion (ROM) of fossil joints. However, this ubiquitous practice carries the assumption that osteological estimates of ROM consistently overestimate true joint mobility. Because studies founded on ROM-based exclusion have contributed substantially to our understanding of functional and locomotor evolution, it is critical that this assumption be tested. Here, we evaluate whether ROM-based exclusion is, as currently implemented, a reliable strategy. We measured the true mobilities of five intact cadaveric joints using marker-based X-ray Reconstruction of Moving Morphology and compared them to virtual osteological estimates of ROM made allowing (a) only all three rotational, (b) all three rotational and one translational, and (c) all three rotational and all three translational degrees of freedom. We found that allowing combinations of motions in all six degrees of freedom is necessary to ensure that true mobility is always successfully captured. In other words, failing to include joint translations in ROM analyses results in the erroneous exclusion of many joint poses that are possible in life. We therefore suggest that the functional and evolutionary conclusions of existing paleobiological reconstructions may be weakened or even overturned when all six degrees of freedom are considered. We offer an expanded methodological framework for virtual ROM estimation including joint translations and outline recommendations for future ROM-based exclusion studies.