Increased Emergency Department Use by TGD Medicare Beneficiaries
A recent research letter published in JAMA Internal Medicine has brought to light the differential use of emergency departments by transgender and gender-diverse (TGD) Medicare beneficiaries. According to the study carried out by researchers at Brown University School of Public Health, TGD Medicare beneficiaries are more likely to use the emergency department than their cisgender counterparts.
The study analyzed national emergency department use among 3,639 TGD and 6,151,389 cisgender Medicare beneficiaries from the years 2011 to 2020. A key finding of the study was that older TGD beneficiaries and TGD beneficiaries with disabilities were particularly prone to using the emergency department, often for mental health care.
The Underlying Reasons
There are multiple reasons why TGD individuals may postpone routine medical care, leading to an increased risk of medical emergencies and poor long-term health outcomes. Among the reasons are enacted discrimination within healthcare settings and barriers in accessing healthcare facilities and services. These barriers are compounded for older TGD individuals and those with disabilities, leading to heightened emergency department utilization.
Moreover, transgender and gender-diverse individuals face a higher risk of physical and mental health conditions compared to their cisgender peers. This factor, combined with the aforementioned challenges in accessing regular healthcare, results in a pattern of increased emergency department use.
Inpatient Admissions from the Emergency Department
Notably, TGD Medicare beneficiaries were also found to be more likely to be admitted to the hospital from the emergency department. This can be seen as another indicator of the health disparities faced by this group, as the need for inpatient care often suggests a higher severity of health conditions or a lack of access to outpatient or preventive care services.
Steps Towards Improvement
The authors of the study have put forth several recommendations to address these disparities. They advocate for training clinicians and front-line staff in TGD-inclusive care and cultural humility. This type of training can help to reduce enacted discrimination in primary care settings, which is a key barrier to healthcare access for TGD individuals.
The use of TGD-specific diagnostic codes is another strategy that has been proposed. Such methodological advances can help in accurately capturing the health needs of TGD populations and in tailoring healthcare services to meet these needs.
This study has shed light on the disparities in emergency department use between TGD and cisgender Medicare beneficiaries. Addressing these disparities requires a multifaceted approach, encompassing both changes in healthcare practices and improvements in data capturing methodologies. By taking these steps, it may be possible to improve healthcare access for TGD Medicare beneficiaries and reduce their reliance on emergency department services.