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Utilization Of Gender-affirming Surgical Services In The United States: A Multi-payor Administrative Claims Analysis
Caleb Haley, MD, Kumaran Arivoli, BS, Zach Eisner, BS, Megan Lane, MD, MS, William Bruce, MD, Jennifer Hamill, MPH, Jessica Hsu, MD, PhD, William Kuzon, MD, PhD.
University of Michigan, Ann Arbor, MI, USA.
PURPOSE: Gender-diverse individuals represent a growing population nationally. Previous work has demonstrated patients are accessing gender-affirming surgical services at increasing rates. However, prior work is limited by small sample sizes or single-institution data. Thus, we aimed to explore demographic information and gender-affirming surgical service utilization in a large administrative claims dataset that includes records from multiple payors.
METHODS: The PearlDiver database, containing administrative claims records from over 165 million patients from 2010 to 2022, was utilized. A sample set was created using ICD and CPT codes specific for gender-diverse individuals. Basic demographic information was collected, as was utilization data using ICD and CPT codes specific for common gender-affirming surgical services.
RESULTS: Of the 183,808 gender-diverse patients identified in the dataset, 16,106 surgical procedures were performed from 13,808 individual patients. Gender-diverse patients have a mean age of 25 years old, are geographically diverse, 88% have obtained at least a high school degree, 94% are employed to some degree, and 90% are insured. Utilization of gender-affirming surgical services increased over time, with mastectomy, hysterectomy, and facial feminization being the highest services by volume.
CONCLUSION: Gender-affirming surgeries are increasing utilized healthcare services in the United States. Although identifying gender-diverse individuals and surgical data within administrative claims databases is challenging, the data contained in these datasets can provide valuable information regarding the demographics and utilization trends of patients undergoing gender-affirming surgical services. Future studies can use administrative claims data to better understand gender-affirming surgery barriers, access, and outcomes.
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