TY - JOUR
T1 - Disparities in Suicidality by Gender Identity Among Medicare Beneficiaries
AU - Progovac, Ana M.
AU - Mullin, Brian O.
AU - Dunham, Emilia
AU - Reisner, Sari L.
AU - McDowell, Alex
AU - Sanchez Roman, Maria Jose
AU - Dunn, Mason
AU - Telingator, Cynthia J.
AU - Lu, Frederick Q.
AU - Breslow, Aaron Samuel
AU - Forstein, Marshall
AU - Cook, Benjamin Lê
N1 - Funding Information:
This work was conducted with support from Harvard Catalyst, The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, NIH Award UL1 TR001102-05), and financial contributions from Harvard University and its affiliated academic healthcare centers. Primary funding is through a subaward pilot grant through Harvard Catalyst (Principal Investigator, Ana Progovac). Additional support was provided through the Center for Medicare and Medicaid Services Office of Minority Health through their Health Equity Data Access Program (Principal Investigator, Benjamin Cook, DUA: RSCH-2017-50712). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or NIH. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Centers for Medicare and Medicaid Services or the U.S. Department of Health and Human Services. The study sponsors did not have any role in the study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication. Brian Mullin reports stock ownership in the following healthcare-related companies: Proctor & Gamble, Shire PLC, Baxter International, Abbott Labs, Bristol-Myers Squibb, and AbbVie Inc. No other financial disclosures were reported by the authors of this paper.
Funding Information:
This work was conducted with support from Harvard Catalyst , The Harvard Clinical and Translational Science Center ( National Center for Research Resources and the National Center for Advancing Translational Sciences , NIH Award UL1 TR001102-05 ), and financial contributions from Harvard University and its affiliated academic healthcare centers. Primary funding is through a subaward pilot grant through Harvard Catalyst (Principal Investigator, Ana Progovac). Additional support was provided through the Center for Medicare and Medicaid Services Office of Minority Health through their Health Equity Data Access Program (Principal Investigator, Benjamin Cook, DUA: RSCH-2017-50712 ).
Publisher Copyright:
© 2020 American Journal of Preventive Medicine
PY - 2020/6
Y1 - 2020/6
N2 - Introduction: Suicidality is higher for gender minorities than the general population, yet little is known about suicidality in disabled or older adult gender minorities. Methods: This study used 2009–2014 Medicare claims to identify people with gender identity–related diagnosis codes (disabled, n=6,678; older adult, n=2,018) and compared their prevalence of suicidality with a 5% random non–gender minority beneficiary sample (disabled, n=535,801; older adult, n=1,700,008). Correlates of suicidality were assessed (via chi-square) for each of the 4 participant groups separately, and then disparities within eligibility status (disabled or older adult) were assessed using logistic regression models, adjusting first for age and mental health chronic conditions and then additionally for Medicaid eligibility, race/ethnicity, or U.S. region (each separately). The primary hypotheses were that gender minority beneficiaries would have higher suicidality but that suicidality disparities would persist after adjusting for covariates. Data were analyzed between 2017 and 2019. Results: Gender minority beneficiaries had higher unadjusted suicidality than non–gender minority beneficiaries in the disabled cohort (18.5% vs 7.1%, p<0.001). Significant suicidality predictors in all 4 groups included the following: age (except in older adult gender minorities), Medicaid eligibility, depression or behavioral health conditions, avoidable hospitalizations, and violence victimization. In age- and mental health–adjusted logistic regression models, gender minorities had higher odds of suicidality than non–gender minority beneficiaries (disabled, OR=1.95, p<0.0001; older adult, OR=2.10, p<0.0001). Disparities were not attenuated after adjusting for Medicaid eligibility, race/ethnicity, or region. Conclusions: Heightened suicidality among identified gender minority Medicare beneficiaries highlights a pressing need to identify and reduce barriers to wellness in this population.
AB - Introduction: Suicidality is higher for gender minorities than the general population, yet little is known about suicidality in disabled or older adult gender minorities. Methods: This study used 2009–2014 Medicare claims to identify people with gender identity–related diagnosis codes (disabled, n=6,678; older adult, n=2,018) and compared their prevalence of suicidality with a 5% random non–gender minority beneficiary sample (disabled, n=535,801; older adult, n=1,700,008). Correlates of suicidality were assessed (via chi-square) for each of the 4 participant groups separately, and then disparities within eligibility status (disabled or older adult) were assessed using logistic regression models, adjusting first for age and mental health chronic conditions and then additionally for Medicaid eligibility, race/ethnicity, or U.S. region (each separately). The primary hypotheses were that gender minority beneficiaries would have higher suicidality but that suicidality disparities would persist after adjusting for covariates. Data were analyzed between 2017 and 2019. Results: Gender minority beneficiaries had higher unadjusted suicidality than non–gender minority beneficiaries in the disabled cohort (18.5% vs 7.1%, p<0.001). Significant suicidality predictors in all 4 groups included the following: age (except in older adult gender minorities), Medicaid eligibility, depression or behavioral health conditions, avoidable hospitalizations, and violence victimization. In age- and mental health–adjusted logistic regression models, gender minorities had higher odds of suicidality than non–gender minority beneficiaries (disabled, OR=1.95, p<0.0001; older adult, OR=2.10, p<0.0001). Disparities were not attenuated after adjusting for Medicaid eligibility, race/ethnicity, or region. Conclusions: Heightened suicidality among identified gender minority Medicare beneficiaries highlights a pressing need to identify and reduce barriers to wellness in this population.
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U2 - 10.1016/j.amepre.2020.01.004
DO - 10.1016/j.amepre.2020.01.004
M3 - Article
C2 - 32156489
AN - SCOPUS:85081229501
SN - 0749-3797
VL - 58
SP - 789
EP - 798
JO - American Journal of Preventive Medicine
JF - American Journal of Preventive Medicine
IS - 6
ER -
