Beyond Gender Identity Disorder Diagnoses Codes: An Examination of Additional Methods to Identify Transgender Individuals in Administrative Databases. Issue 10 (October 2020)

• Record Type: Journal Article
• Authors: Jasuja, Guneet K.; de Groot, Alexander; Quinn, Emily K.; Ameli, Omid; Hughto, Jaclyn M.W.; Dunbar, Michael; Deutsch, Madeline; Streed, Carl G.; Paasche-Orlow, Michael K.; Wolfe, Hill L.; Rose, Adam J.
• Is Part Of: Medical care. Volume 58:Issue 10(2020)
• Publication Date: 2020-10
• Subjects: transgender -- gender dysphoria -- gender identity disorder -- identification methods -- administrative data; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001362
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Large administrative databases often do not capture gender identity data, limiting researchers' ability to identify transgender people and complicating the study of this population. Objective: The objective of this study was to develop methods for identifying transgender people in a large, national dataset for insured adults. Research Design: This was a retrospective analysis of administrative claims data. After using gender identity disorder (GID) diagnoses codes, the current method for identifying transgender people in administrative data, we used the following 2 strategies to improve the accuracy of identifying transgender people that involved: (1) Endocrine Disorder Not Otherwise Specified (Endo NOS) codes and a transgender-related procedure code; or (2) Receipt of sex hormones not associated with the sex recorded in the patient's chart (sex-discordant hormone therapy) and an Endo NOS code or transgender-related procedure code. Subjects: Seventy-four million adults 18 years and above enrolled at some point in commercial or Medicare Advantage plans from 2006 through 2017. Results: We identified 27, 227 unique transgender people overall; 18, 785 (69%) were identified using GID codes alone. Using Endo NOS with a transgender-related procedure code, and sex-discordant hormone therapy with either Endo NOS or transgender-related procedure code, we added 4391 (16%) and 4051 (15%) transgender people, respectively. Of the 27, 227 transgender people in our cohort, 8694 (32%) were transmasculine, 3959 (15%) were transfeminine, and 14, 574 (54%) could not be classified. Conclusion: In the absence of gender identity data, additional data elements beyond GID codes improves the identification of transgender people in large, administrative claims databases. Abstract : Supplemental Digital Content is available in the text.