• Ana M Progovac, Brian O Mullin, Emilia Dunham, Sari L Reisner, Alex McDowell, Maria Jose Sanchez Roman, Mason Dunn, Cynthia J Telingator, Frederick Q Lu, Aaron Samuel Breslow, Marshall Forstein, and Benjamin Lê Cook.
• Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts. Electronic address: aprogovac@cha.harvard.edu.
• Am J Prev Med. 2020 Jun 1; 58 (6): 789-798.

IntroductionSuicidality is higher for gender minorities than the general population, yet little is known about suicidality in disabled or older adult gender minorities.MethodsThis 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.ResultsGender 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.ConclusionsHeightened suicidality among identified gender minority Medicare beneficiaries highlights a pressing need to identify and reduce barriers to wellness in this population.Copyright © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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