PROJECT SUMMARY
Transgender and gender diverse (TGD) people in the United States (US) experience significant health disparities
throughout the life course relative to cisgender people. While extensive community-based research drawn from
convenience samples and a burgeoning body of research using population-level data has assessed the
healthcare utilization of TGD individuals, much of this research has focused on younger TGD people. Little
national data exist on the health of older TGD people (i.e., 55 and older). Older adults, regardless of gender
identity, are at increased risk of developing comorbidities that burden the healthcare system. TGD older adults
are expected to be at even higher risk of developing multiple, concurrent health problems than cisgender people
due to the stigma-related stress they experience throughout their lives. Further, like all people, TGD people
require routine care and, often acute and post-acute care as they age; however, TGD individuals also have
unique medical gender affirmation needs (e.g., hormones or surgery) and a dearth of research has explored the
ways in which the use of these services shape older TGD people's use of other routine and acute care. The
long-term goal of this research agenda is to improve healthcare quality and ultimately the health of older TGD
people. The overall objective of this study is to create a comprehensive understanding of the comorbidities and
healthcare use of older TGD adults. Consistent with NOT-MD-19-001: “Research on the Health of Sexual and
Gender Minority (SGM) Population,” we propose to do use novel algorithms to identify a sample of 30,000+ older
TGD people in Medicare data and follow their outcomes across 10 years of outpatient, acute- and post-acute
claims and assessment data. We will also link Medicare data to state-level data and use qualitative methods to
understand the multilevel factors that shape health outcomes for older TGD adults. To achieve these goals, we
propose the following Aims: 1) To describe the prevalence and incidence of single and comorbid chronic
conditions among TGD Medicare beneficiaries and to compare the healthcare utilization of TGD and cisgender
beneficiaries; 2) To understand how individual, healthcare system, and community factors influence health and
healthcare use of older TGD adults relative to older cisgender adults; and 3) To contextualize the quantitative
findings by qualitatively assessing (via patient and provider interviews) the individual, healthcare system, and
community-level barriers and facilitators to optimal health and healthcare utilization for older TGD adults that can
be addressed in future multilevel interventions. This project is innovative because we will use datasets, methods,
and outcomes that have not been previously applied to understanding the health of the older adult TGD
population. This work will have a significant impact as it will yield novel, clinically-important, and policy-relevant
evidence about how older TGD adults are cared for as they become more significantly ill. Finally, completion of
this study will lay the groundwork for future multilevel interventions to improve the care of and health of the older
TGD population in the US.
