Study data published in the American Journal of Preventative Medicine identified a significant association between gender minority status and suicidality among Medicare beneficiaries.
Ana M. Progovac, PhD, from the Health Equity Research Lab, department of psychiatry, Cambridge Health Alliance, Massachusetts, and colleagues abstracted data from Medicare billing claims from 2009 to 2014. Beneficiaries with gender identity-related diagnosis codes were compared with a 5% random sample of beneficiaries without gender minority status. Relevant diagnosis codes included codes for gender identity-related treatment, such as hormone replacement therapy, and diagnosis of gender dysphoria, and suicidality included any suicide attempt, potential suicide attempt, or suicidal ideation.
The researchers conducted chi-square analyses to identify correlates of suicidality in the gender minority and non-gender minority groups and logistic regression to assess suicidality risk by age and disability status. Analyses were adjusted for age, mental health conditions, Medicaid eligibility, race/ethnicity, and region of residence.
A total of 4 groups were analyzed: (1) gender minority beneficiaries with disabilities (n=6678); (2) gender minority beneficiaries aged >65 years (n=2018); (3) non-gender minority beneficiaries with disabilities (n=535,801); and (4) older adult non-gender minority beneficiaries (n=1,700,008). In unadjusted analyses, gender minority beneficiaries with disabilities were more likely than their non-gender minority counterparts to have a suicide attempt (5.1% vs 1.3%), suicidal ideation (15.4% vs 3.5%), and a potential suicide attempt (6.5% vs 4.3%) in 2009 to 2014 (all P <.0001).
Older adult gender minorities were more likely to have a suicide attempt (0.5% vs 0.1%) and report suicidal ideation (1.1% vs 0.4%) but less likely to have a potential suicide attempt (1.7% vs 3.1%; P <.0002) than older adult non-gender minorities. Significant predictors of suicidality in all patient groups included age (younger or >75 years), Medicaid eligibility, depression or other behavioral health conditions, avoidable hospitalizations, and any “violence victimization.” In logistic regression models adjusted for age and behavioral health conditions, gender minority patients had higher odds of suicidality in both the disabled (OR, 1.95; 95% CI, 1.82-2.09; P <.0001) and older adult (OR, 2.10; 95% CI, 1.60-2.75; P <.0001) cohorts.
Study limitations include the use of diagnostic codes to describe gender and quantify suicidality, and that the results may not be generalizable to all patients of gender minority status. Even so, the data support the routine assessment of self-reported gender identity in healthcare databases to facilitate care access and provide behavioral health interventions to those who need it.
Disclosure: A study author declared affiliations with the pharmaceutical industry.
Please see the original reference for a full list of authors’ disclosures.
Progovac AM, Mullin BO, Dunham E, et al. Disparities in suicidality by gender identity among Medicare beneficiaries [published online March 7, 2020]. Am J Prev Med. doi: 10.1016/j.amepre.2020.01.004