ED Use Increased for Transgender, Gender-Diverse Medicare Beneficiaries

TGD beneficiaries more likely than cisgender beneficiaries to use emergency department for mental health care

By Elana Gotkine HealthDay Reporter

MONDAY, Feb. 12, 2024 (HealthDay News) — Transgender and gender-diverse (TGD) Medicare beneficiaries are more likely to use the emergency department than their cisgender peers, according to a research letter published online Feb. 12 in JAMA Internal Medicine.

Gray Babbs, M.P.H., from the Brown University School of Public Health in Providence, Rhode Island, and colleagues examined national emergency department use among TGD beneficiaries and cisgender beneficiaries using data from 2011 to 2020. The analyses included 3,639 TGD and 6,151,389 cisgender Medicare beneficiaries.

The researchers found that compared with cisgender beneficiaries, older TGD beneficiaries (aged 65 years and older) were more likely to use the emergency department in a year (20.2 percentage points; relative difference, 172.9 percent); TGD beneficiaries with disabilities were also more likely than cisgender beneficiaries with disabilities to use the emergency department (27.8 percentage points; relative difference, 157.4 percent). For TGD individuals, the increases in likelihood were similar for emergent and nonemergent conditions. Compared with cisgender beneficiaries, TGD beneficiaries were more likely to use the emergency department for mental health care. Furthermore, disabled TGD beneficiaries were more likely to use the emergency department for mental health care than cisgender disabled beneficiaries (7.3 versus 1.2 percent; relative difference, 486.5 percent). In the older group and the group with disabilities, TGD beneficiaries were more likely to be admitted to the hospital from the emergency department (2.0 percentage points for both; relative differences, 67.1 and 38.7 percent, respectively).

“Clinicians and front-line staff should be trained in TGD-inclusive care and cultural humility to reduce enacted discrimination in primary care settings and reduce emergency department utilization for TGD Medicare beneficiaries,” the authors write.

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