COVID-19 Diagnoses and Hospitalizations Among Insured Transgender and Gender-Diverse People Restricted; Files Only
Saxena, Vinita (Fall 2024)
Abstract
Background: Transgender and gender-diverse (TGD) people may be disproportionately affected by the COVID-19 pandemic, potentially due to factors such as hormone makeup or access to quality care. There is minimal data on the effects of COVID-19 on TGD populations, and the potential role of gender-affirming hormone therapy (GAHT) on COVID-19 diagnosis and severity has not been well-studied.
Methods: Electronic health records (EHRs) were used to identify and validate a cohort of 10,156 transfeminine (TF) and 15,687 transmasculine (TM) Kaiser Permanente members who were enrolled in four locations from January 1, 2020 to May 11, 2023. Each TGD participant had up to ten matched cisgender female (CF) and cisgender male (CM) controls, matched on age, race or ethnicity, and study site. Analysis conducted included incident rates of first COVID-19 diagnosis, rates of hospitalization, and hazard ratios (HRs) for COVID-19 diagnosis and hospitalization, ascertained from Cox regression models.
Results: Approximately half of participants in both cohorts (48.5% TF, 56.4% TM) were diagnosed with COVID-19. The hazard ratio for COVID-19 diagnosis in the TF cohort was 0.90 (95% CI, 0.87 to 0.93) compared to CF controls, and 1.15 (95% CI, 1.11 to 1.20) compared to CM controls. For the TM cohort, the hazard ratio for COVID-19 diagnosis was 1.13 (95% CI, 1.10 to 1.16) compared to CF controls, and 1.49 (95% CI, 1.45 to 1.53) compared to CM controls. The hazard ratios for hospitalization in both TF and TM cohorts indicated decreased hazard compared to CF controls and increased hazard compared to CM controls. When restricting to only those on GAHT, we found very few differences in hazard ratios for both TF and TM participants compared to their CF and CM controls.
Conclusions: We found that TM populations had higher rates of COVID-19 diagnosis compared with both CF and CM controls, and TF populations were diagnosed with COVID-19 at higher rates than CM controls. It is crucial to prioritize TGD populations when conducting public health interventions and inclusive clinical care.
Table of Contents
Table of Contents
INTRODUCTION ... 1
METHODS ... 3
RESULTS ... 7
DISCUSSION ... 10
STRENGTHS AND LIMITATIONS ... 13
CONCLUSIONS ... 14
REFERENCES ... 15
FIGURES ... 24
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