COVID-19 testing, infections, and hospital admissions among people who identify as transgender / Michael Goodman.

Format:

Book

Author/Creator:

Goodman, Michael, author.

Language:

English

Subjects (All):

COVID-19 (Disease).

Physical Description:

1 online resource

Place of Publication:

Washington (DC) : Patient-Centered Outcomes Research Institute (PCORI), 2023.

Summary:

BACKGROUND: Transgender and gender-diverse (TGD) people may be disproportionately affected by the COVID-19 pandemic because they may face barriers to timely care and because they may be at higher risk for severe disease because of possible interaction between COVID-19 infection and gender-affirming hormone therapy. OBJECTIVES: In this analysis of data from the Study of Transition, Outcomes & Gender nested in Kaiser Permanente health plans in northern and southern California, we sought to characterize the potential impact of the COVID-19 pandemic among TGD people enrolled at participating sites by comparing rates of COVID-19 testing and diagnoses in transfeminine (TF) and transmasculine (TM) participants relative to cisgender referents. In addition, data on COVID-19 cases among TGD and cisgender study participants were analyzed to assess the likelihood of hospitalization in the 2 groups. METHODS: Electronic health records (EHRs) were used to identify and validate a cohort of 6774 TM and 4607 TF Kaiser Permanente members who were enrolled in the 2 participating plans from January 1, 2020, through July 31, 2021. Ten cisgender male (CM) and 10 cisgender female (CF) enrollees were matched to each TGD cohort member on year of birth, race or ethnicity, and study site. Rates of COVID-19 testing and diagnoses and hospitalizations within 30 days of diagnosis among TGD cohort members were ascertained from the EHR and compared with those in the reference cohorts via Cox regression models, with results expressed as hazard ratios (HRs) and 95% CIs. RESULTS: The rate of COVID-19 testing was 18% higher (HR, 1.18 [95% CI, 1.13-1.24]) among TF cohort members than among matched CF referents and 51% higher (HR, 1.51 [95% CI, 1.44-1.59]) when the reference group consisted of CM study participants. TM study participants also had significantly higher rates of COVID-19 testing, with HR estimates of 1.34 (95% CI, 1.29-1.40) relative to CF referents and 1.74 (95% CI, 1.68-1.81) relative to CM referents. The HR (95% CI) estimates for COVID-19 incidence rates comparing TF and CF and CM cohort members were 0.64 (0.56-0.73) and 0.71 (0.62-0.81), respectively. Similarly, TM participants were approximately 30% to 40% less likely to receive a COVID-19 diagnosis than cisgender referents, with all 95% CI estimates excluding unity. Although the unadjusted analyses suggested that hospitalization rates were higher among TF patients with COVID-19 than among cisgender referents, the association was attenuated and was not statistically significant after the results were controlled for covariates. More importantly, the association was no longer evident once the analyses were restricted to TF patients with evidence of gender-affirming hormone therapy receipt. The corresponding analyses for TM patients with COVID-19 produced essentially results. CONCLUSIONS: In this analysis of the data from an EHR-based cohort nested within 2 large integrated health systems, there was no evidence that TGD people were disproportionately affected by the COVID-19 pandemic in terms of rates of testing and rates and severity of disease. LIMITATIONS: Though reassuring, the results of this study must be interpreted with caution because the data are limited to participants with adequate access to care and included few cases of COVID-19 that necessitated intensive care. Although COVID-19 testing and diagnoses from outside the system are documented in Kaiser Permanente records, the completeness of this documentation is not clear.

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