Is gender dysphoria associated with increased hospital charges in patients hospitalized for depression? Focus on the racial and regional variance in US hospitals (Preprint)

Abstract

Individuals with gender dysphoria do not identify with their sex assigned at birth and face societal and cultural challenges leading to increased risk for depression, anxiety, and suicide. Additionally, individuals with gender dysphoria or who identify as gender diverse/nonconforming may experience “minority stress” from increased discrimination, leading to a greater risk for mental health problems.

This study aimed to identify possible health disparities in patients with gender dysphoria and hospitalized for depression across the United States. Various patient and hospital-related factors are explored for their association with changes in healthcare utilization for patients hospitalized with depression.

The National Inpatient Sample was used to identify nationwide patients with depression (n= 378,552, weighted n= 1,892,760) from 2016 to 2019. We then examined the characteristics of the study sample and investigated how individuals' gender dysphoria was associated with healthcare utilization measured by hospital charges. Multivariate survey regression models were used to identify predictors.

Among the 1,892,760 total patient samples, 14,145 (0.7%) patients had gender dysphoria. Over the study periods, hospitalization rates for depression for patients with gender dysphoria continuously increased, but total depression inpatient rates remained stable. Survey regression results suggested that gender dysphoria, minority ethnicity or race, female sex assigned at birth, older ages, and specific hospital regions were associated with higher hospital charges than their reference groups. Sub-group analysis showed that the trend was similar in most racial and regional groups.

Differences in hospital charges for depression in patients with gender dysphoria exemplify how this community has been disproportionally affected by racial and regional biases, insurance denials, and economic disadvantages. Financial concerns can stop individuals from accessing gender-affirming care and risk more significant mental health problems. Increased complexity and comorbidity are associated with hospital charges and add to the cycle.