COVID-19 DIAGNOSES AND HOSPITALIZATIONS AMONG INSURED TRANSGENDER AND GENDER DIVERSE PEOPLE IN CALIFORNIA, USA Restricted; Files Only
Donegan, Chloe (Spring 2024)
Published
Abstract
Background: Transgender and gender diverse (TGD) people may be disproportionately affected by the COVID‐19 pandemic due to barriers to timely care. Further, the potential role of gender- affirming hormone therapy on COVID-19 severity has not been well-studied.
Specific Aims: In this analysis of data from the Study of Transition, Outcomes & Gender nested in Kaiser Permanente health systems in Northern and Southern California, we sought to compare rates of COVID‐19 diagnoses in transfeminine (TF) and transmasculine (TM) participants relative to cisgender referents. In addition, data on COVID‐19 cases among TGD and cisgender study participants were analyzed to compare the likelihood of hospitalization in these groups.
Methods: Electronic health records (EHRs) were used to identify and validate a cohort of 6774 TM and 4607 TF Kaiser Permanente members who were enrolled in the 2 participating plans from January 1, 2020, through July 31, 2021. About 10 cisgender male (CM) and 10 cisgender female (CF) enrollees were matched to each TGD cohort member on year of birth, race or ethnicity, and study site. Rates of incident COVID‐19 diagnoses and hospitalizations within 30 days of diagnosis among TGD cohort members were ascertained from the EHR and compared with those in the reference cohorts via Cox regression models, with results expressed as hazard ratios (HRs) and 95% CIs before and after adjusting for potential cofounding factors. Sensitivity analyses among TGD members on hormone therapy were also explored.
Results: COVID‐19 incidence rates were lower in TF cohort members compared with CF and CM referents with HR (95% CI) estimates of 0.64 (0.56-0.73) and 0.71 (0.62-0.81), respectively. Similarly, TM participants were approximately 30% to 40% less likely to receive a COVID‐19 diagnosis than cisgender referents, with all 95% CI estimates excluding unity. Although the unadjusted analyses suggested that hospitalization rates were higher among TF patients with COVID‐19 than among cisgender referents, the association was attenuated after the results were controlled for covariates. More importantly, the association was no longer evident once the analyses were restricted to TF patients with evidence of gender-affirming hormone therapy receipt.
Conclusions: In this analysis of data from two large integrated health systems, there was no evidence that TGD people were disproportionately diagnosed or hospitalized with COVID‐19. Although reassuring, the results of this study must be interpreted with caution because the data are limited to participants with COVID-19 diagnoses (not confirmed with tests), adequate access to care, and included only a few cases of diagnosed COVID‐19 that necessitated intensive care.
Table of Contents
INTRODUCTION
METHODS
Cohort Ascertainment
Data Linkages and Variable Characterization
Statistical Analyses
RESULTS
DISCUSSION
STRENGTHS AND LIMITATIONS
CONCLUSIONS
REFERENCES
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File download under embargo until 20 May 2025 | 2024-05-02 15:33:24 -0400 | File download under embargo until 20 May 2025 |
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