Chronic conditions among transgender Medicare beneficiaries: Variation by race, ethnicity, and Medicaid dual-enrollment

Background: Transgender and gender diverse (TGD) adults experience disability at twice the rate of cisgender (non-TGD) adults in the US. TGD people of color and low-income TGD people experience intersecting discrimination that may compound chronic conditions and disability. To our knowledge, no research has focused on chronic conditions among TGD Medicare beneficiaries with disabilities. Objective: We compared the probability of chronic conditions among TGD adults with disability-based eligibility for Medicare across race, ethnicity, and dual Medicaid-Medicare enrollment. Methods: We used cross-sectional Medicare enrollment and claims data between 2008 and 2017 for fee-for-service beneficiaries eligible based on disability. We applied a claims-based algorithm to identify TGD beneficiaries. We assessed differences in beneficiaries' age-adjusted predicted probability of chronic conditions across race, ethnicity, and dual eligibility. Results: Dual-eligible TGD beneficiaries (N = 8041) had a higher predicted probability of nine out of ten health condition categories relative to Medicare-only TGD beneficiaries (N = 6237). For each race and ethnicity category, the most prevalent condition categories were mental health, cardiovascular conditions, and non- cardiovascular-related physical health conditions. Hispanic and non-Hispanic Black TGD beneficiaries had over two and three times the probability of infectious disease as non-Hispanic White TGD beneficiaries, respectively. Conclusions: TGD adults with disabilities have high rates of chronic conditions with additional disparities by race, ethnicity, and dual eligibility status. Our findings offer potential directions for mixed-methods and intervention research aimed at identifying and ameliorating the drivers of these disparities among TGD Medicare beneficiaries with disabilities.