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.