Disparities in Suicidality by Gender Identity Among Medicare Beneficiaries.
Adult
Aged
Aged, 80 and over
Cohort Studies
Depression
/ psychology
Disabled Persons
/ statistics & numerical data
Eligibility Determination
Female
Humans
Insurance Claim Review
/ statistics & numerical data
Male
Medicaid
/ statistics & numerical data
Medicare
/ statistics & numerical data
Middle Aged
Sexual and Gender Minorities
/ statistics & numerical data
Suicide
/ statistics & numerical data
United States
Journal
American journal of preventive medicine
ISSN: 1873-2607
Titre abrégé: Am J Prev Med
Pays: Netherlands
ID NLM: 8704773
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
14
05
2019
revised:
01
01
2020
accepted:
02
01
2020
pubmed:
12
3
2020
medline:
26
2
2021
entrez:
12
3
2020
Statut:
ppublish
Résumé
Suicidality is higher for gender minorities than the general population, yet little is known about suicidality in disabled or older adult gender minorities. This study used 2009-2014 Medicare claims to identify people with gender identity-related diagnosis codes (disabled, n=6,678; older adult, n=2,018) and compared their prevalence of suicidality with a 5% random non-gender minority beneficiary sample (disabled, n=535,801; older adult, n=1,700,008). Correlates of suicidality were assessed (via chi-square) for each of the 4 participant groups separately, and then disparities within eligibility status (disabled or older adult) were assessed using logistic regression models, adjusting first for age and mental health chronic conditions and then additionally for Medicaid eligibility, race/ethnicity, or U.S. region (each separately). The primary hypotheses were that gender minority beneficiaries would have higher suicidality but that suicidality disparities would persist after adjusting for covariates. Data were analyzed between 2017 and 2019. Gender minority beneficiaries had higher unadjusted suicidality than non-gender minority beneficiaries in the disabled cohort (18.5% vs 7.1%, p<0.001). Significant suicidality predictors in all 4 groups included the following: age (except in older adult gender minorities), Medicaid eligibility, depression or behavioral health conditions, avoidable hospitalizations, and violence victimization. In age- and mental health-adjusted logistic regression models, gender minorities had higher odds of suicidality than non-gender minority beneficiaries (disabled, OR=1.95, p<0.0001; older adult, OR=2.10, p<0.0001). Disparities were not attenuated after adjusting for Medicaid eligibility, race/ethnicity, or region. Heightened suicidality among identified gender minority Medicare beneficiaries highlights a pressing need to identify and reduce barriers to wellness in this population.
Identifiants
pubmed: 32156489
pii: S0749-3797(20)30053-2
doi: 10.1016/j.amepre.2020.01.004
pmc: PMC7246148
mid: NIHMS1573543
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
789-798Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001102
Pays : United States
Informations de copyright
Copyright © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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