Chronic Conditions and Health Care Use Comparison Between Transgender/Gender Diverse and Cisgender Medicare Beneficiaries

Purpose: We compared how transgender and gender diverse (TGD) and cisgender adults in the United States develop age-related chronic conditions and use health care throughout their lives.Methods: Using an established algorithm, we identified TGD beneficiaries in Medicare claims data from 2011 to 2020. We identified the 10 nearest-neighbor cisgender matches for each TGD beneficiary based on propensity scores estimated from the original basis of eligibility, years of Medicare enrollment, race, ethnicity, age, and hospital service area. Our primary outcomes were chronic conditions and health care utilization variables as measured by the Chronic Conditions Warehouse. We used generalized estimating equations with a logit link to compare age-related chronic conditions and health utilization between the TGD and matched cisgender cohorts, controlling for original eligibility, years of Medicare enrollment, race, ethnicity, and age. We plotted age-related chronic conditions and health care utilization over age for TGD and cisgender beneficiaries.Results: We identified 38,187 TGD Medicare beneficiaries. We found that TGD beneficiaries had higher rates of age-related chronic conditions than cisgender beneficiaries. These disparities grew as beneficiaries aged for endocrine and renal conditions, musculoskeletal conditions and chronic pain, and neurological conditions. TGD beneficiaries were more likely to use inpatient, outpatient, emergency department, skilled nursing facility, home health, and dialysis care than cisgender beneficiaries.Conclusion: As the number of TGD-identified adults grows, these findings underscore the need for Medicare to create policies and programs that address the needs of TGD beneficiaries.