Transgender, gender-diverse patients face higher odds of ED use, hospital admission

Key takeaways:

• Both older TGD and TGD with disabilities were likelier to use the ED vs. cisgender patients.
• Researchers underscored the need for clinicians and front-line staff to be trained in TGD-inclusive care.

Older transgender and gender-diverse patients on Medicare were more likely to use the ED — particularly for mental health care — than cisgender beneficiaries, according to a study published in JAMA Internal Medicine.

“Transgender and gender-diverse (TGD) people face substantial societal stigma due to their identities in health care settings,” Gray Babbs, MPH, a PhD student in the department of health services, policy and practice at Brown University School of Public Health, and colleagues wrote. “TGD individuals often postpone routine medical care due to various reasons, including anticipated discrimination, lack of knowledgeable clinicians, and costs.”

They explained that these delays “are associated with medical emergencies and poor long-term health outcomes.”

In the study, the researchers examined data from TGD (n = 3,693) and cisgender (n = 6,151,389) Medicare beneficiaries spanning 2011 to 2020. Their ED use patterns were compared based on age and disability status.

TGD beneficiaries aged 65 years and older were 20.2 percentage points (95% CI, 18.5-21.9) more likely to use the ED in a year than cisgender beneficiaries in the same age group, for a relative difference of 172.9%. Meanwhile, TGD beneficiaries with disabilities were 27.8 percentage points (95% CI, 26.1-29.6) likelier to use the ED in a year than cisgender beneficiaries with disabilities, for a relative difference of 157.4%.

“TGD people had similar increases in likelihood for emergent and nonemergent conditions,” Babbs and colleagues wrote.

They also noted that TGD beneficiaries with disabilities were 6 percentage points (95% CI, 5.3-6.7) more likely to use the ED for mental health care vs. cisgender beneficiaries with disabilities, a relative difference of 486.5%.

TGD beneficiaries in both the older group (2 percentage points; 95% CI, 1.3-2.7) and the group with disabilities (2 percentage points; 95% CI, 1.2-2.8) were more likely to be admitted to the hospital from the ED.

The researchers pointed out that the results highlight “upstream implications of delays in seeking timely health care.”

The study had some limitations, however. Babbs and colleagues explained that although there was a large study sample, it was limited to Medicare fee-for-service individuals, and there was a possibility for misclassification of TGD or cisgender status.

“Clinicians and frontline staff should be trained in TGD-inclusive care and cultural humility to reduce enacted discrimination in primary care settings and reduce ED utilization for TGD Medicare beneficiaries,” they concluded.