TY - JOUR
T1 - Change in Gender on Record and Transgender Adults’ Mental or Behavioral Health
AU - Yee, Kimberly
AU - Lind, Bonnie K.
AU - Downing, Jae
N1 - Funding Information:
The authors thank community members and providers participating in OHSU's Transgender Health Program for their thoughtful and detailed feedback on our algorithm for inferring sex assigned at birth. The authors also thank Ellena Rosenthal for their assistance in identifying and compiling diagnosis and procedure codes for this algorithm. The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of NIH. Research reported in this publication was supported by National Institute on Minority Health and Health Disparities (3R01MD011212-0S31 [Administrative Supplement to 1R01MD011212], Principal Investigator: McConnell), and JD's time was supported by the National Institute on Drug Abuse (1K01DA050775-01A1, Principal Investigator: JD). No financial disclosures were reported by the authors of this paper.
Funding Information:
Research reported in this publication was supported by National Institute on Minority Health and Health Disparities (3R01MD011212-0S31 [Administrative Supplement to 1R01MD011212], Principal Investigator: McConnell), and JD's time was supported by the National Institute on Drug Abuse (1K01DA050775-01A1, Principal Investigator: JD).
Publisher Copyright:
© 2021 American Journal of Preventive Medicine
PY - 2021
Y1 - 2021
N2 - Introduction: Within gender-diverse populations, gender-affirming changes in gender on record may improve mental or behavioral health. This study uses claims data to investigate whether sex assigned at birth modifies the association between change in gender on record and mental or behavioral health. Methods: Adult Oregon Medicaid beneficiaries with gender identity–related diagnoses and enrolled during 2010–2019 were included. Sex assigned at birth was inferred from medical and pharmacy claims and was categorized as assigned female, assigned male, or unknown sex assigned at birth. Self-reported gender ascertained at initial enrollment differing from sex assigned at birth indicated a change in gender on record. Multivariable logistic regression estimated the association between change in gender on record and mental (anxiety, depression, suicidal ideation, post-traumatic stress disorder) or behavioral (alcohol, substance, or tobacco use disorders) health. Analyses were conducted in February 2021. Results: This study included 2,940 transgender and nonbinary adults. Of the 1,451 self-reporting female gender and 1,489 self-reporting male gender, 449 (30.9%) were assigned male at birth, and 303 (20.3%) were assigned female at birth, classified as changing their gender on record. Predicted probability of mental or behavioral conditions was significantly lower in those who changed their gender on record. Sex assigned at birth modified the association with mental health: assigned female at birth reporting female gender had the highest burdens, followed by assigned male at birth reporting male. Secondary analyses using a modified change in gender definition or alternative sex assigned at birth inference method found similar trends. Conclusions: Oregon Medicaid gender-diverse beneficiaries who changed their gender on record had a meaningfully lower probability of mental and behavioral health conditions. Those assigned female at birth reporting female gender had the highest burdens.
AB - Introduction: Within gender-diverse populations, gender-affirming changes in gender on record may improve mental or behavioral health. This study uses claims data to investigate whether sex assigned at birth modifies the association between change in gender on record and mental or behavioral health. Methods: Adult Oregon Medicaid beneficiaries with gender identity–related diagnoses and enrolled during 2010–2019 were included. Sex assigned at birth was inferred from medical and pharmacy claims and was categorized as assigned female, assigned male, or unknown sex assigned at birth. Self-reported gender ascertained at initial enrollment differing from sex assigned at birth indicated a change in gender on record. Multivariable logistic regression estimated the association between change in gender on record and mental (anxiety, depression, suicidal ideation, post-traumatic stress disorder) or behavioral (alcohol, substance, or tobacco use disorders) health. Analyses were conducted in February 2021. Results: This study included 2,940 transgender and nonbinary adults. Of the 1,451 self-reporting female gender and 1,489 self-reporting male gender, 449 (30.9%) were assigned male at birth, and 303 (20.3%) were assigned female at birth, classified as changing their gender on record. Predicted probability of mental or behavioral conditions was significantly lower in those who changed their gender on record. Sex assigned at birth modified the association with mental health: assigned female at birth reporting female gender had the highest burdens, followed by assigned male at birth reporting male. Secondary analyses using a modified change in gender definition or alternative sex assigned at birth inference method found similar trends. Conclusions: Oregon Medicaid gender-diverse beneficiaries who changed their gender on record had a meaningfully lower probability of mental and behavioral health conditions. Those assigned female at birth reporting female gender had the highest burdens.
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U2 - 10.1016/j.amepre.2021.10.016
DO - 10.1016/j.amepre.2021.10.016
M3 - Article
AN - SCOPUS:85121702368
JO - American Journal of Preventive Medicine
JF - American Journal of Preventive Medicine
SN - 0749-3797
ER -