Estimating Transgender and Gender- Diverse Youth Populations in Health Systems and Survey Data

Nicole F. Kahn; Gina M. Sequeira; Peter G. Asante; Kacie M. Kidd; Tumaini R. Coker; Dimitri A. Christakis; Baer Karrington; Tandy Aye; Lee Ann E. Conard; Nadia Dowshen; Anne E. Kazak; Leena Nahata; Natalie J. Nokoff; Raina V. Voss; Laura P. Richardson

doi:10.1542/peds.2023-065197

Estimating Transgender and Gender- Diverse Youth Populations in Health Systems and Survey Data

Nicole F. Kahn^*, Gina M. Sequeira, Peter G. Asante, Kacie M. Kidd, Tumaini R. Coker, Dimitri A. Christakis, Baer Karrington, Tandy Aye, Lee Ann E. Conard, Nadia Dowshen, Anne E. Kazak, Leena Nahata, Natalie J. Nokoff, Raina V. Voss, Laura P. Richardson

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

OBJECTIVES: To identify and examine demographic variation in estimates of gender-diverse youth (GDY) populations from the PEDSnet learning health system network and the Youth Risk Behavior Survey (YRBS). METHODS: The PEDSnet sample included 14- to 17-years-old patients who had $2 encounters at a member institution before March 2022, with at least 1 encounter in the previous 18 months. The YRBS sample included pooled data from 14- to 17-year-old in-school youth from the 2017, 2019, and 2021 survey years. Adjusted logistic regression models tested for associations between demographic characteristics and gender dysphoria (GD) diagnosis (PEDSnet) or selfreported transgender identity (YRBS). RESULTS: The PEDSnet sample included 392 348 patients and the YRBS sample included 270 177 youth. A total of 3453 (0.9%) patients in PEDSnet had a GD diagnosis and 5262 (1.9%) youth in YRBS self-identified as transgender. In PEDSnet, adjusted logistic regression indicated significantly lower likelihood of GD diagnosis among patients whose electronic medical record-reported sex was male and among patients who identified as Asian, Black/African American, and Hispanic/Latino/a/x/e. In contrast, in the YRBS sample, only youth whose sex was male had a lower likelihood of transgender identity. CONCLUSIONS: GDY are underrepresented in health system data, particularly those whose electronic medical record-reported sex is male, and Asian, Black/African American, and Hispanic/Latino/a/ x/e youth. Collecting more accurate gender identity information in health systems and surveys may help better understand the health-related needs and experiences of GDY and support the development of targeted interventions to promote more equitable care provision.

Original language	English (US)
Article number	e2023065197
Journal	Pediatrics
Volume	153
Issue number	6
DOIs	https://doi.org/10.1542/peds.2023-065197
State	Published - Jun 1 2024

Funding

FUNDING: Supported by the Health Resources and Services Administration of the US Department of Health and Human Services under the Autism Secondary Data Analysis Research Program (1 R41MC42490-01-00), and grants from the Seattle Children\u2019s Center for Diversity and Health Equity (HE-FY22-SG-19, Drs Sequeira and Kahn) and the Seattle Children\u2019s Research Institute Career Development Award Program (principal investigator Dr Kahn). The sponsors had no role in the design or conduct of the study. The information, content, and/or conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by the Health Resources and Services Administration, the US Department of Health and Human Services, or the US government.

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

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10.1542/peds.2023-065197

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Kahn, N. F., Sequeira, G. M., Asante, P. G., Kidd, K. M., Coker, T. R., Christakis, D. A., Karrington, B., Aye, T., Conard, L. A. E., Dowshen, N., Kazak, A. E., Nahata, L., Nokoff, N. J., Voss, R. V., & Richardson, L. P. (2024). Estimating Transgender and Gender- Diverse Youth Populations in Health Systems and Survey Data. Pediatrics, 153(6), Article e2023065197. https://doi.org/10.1542/peds.2023-065197

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title = "Estimating Transgender and Gender- Diverse Youth Populations in Health Systems and Survey Data",

abstract = "OBJECTIVES: To identify and examine demographic variation in estimates of gender-diverse youth (GDY) populations from the PEDSnet learning health system network and the Youth Risk Behavior Survey (YRBS). METHODS: The PEDSnet sample included 14- to 17-years-old patients who had $2 encounters at a member institution before March 2022, with at least 1 encounter in the previous 18 months. The YRBS sample included pooled data from 14- to 17-year-old in-school youth from the 2017, 2019, and 2021 survey years. Adjusted logistic regression models tested for associations between demographic characteristics and gender dysphoria (GD) diagnosis (PEDSnet) or selfreported transgender identity (YRBS). RESULTS: The PEDSnet sample included 392 348 patients and the YRBS sample included 270 177 youth. A total of 3453 (0.9%) patients in PEDSnet had a GD diagnosis and 5262 (1.9%) youth in YRBS self-identified as transgender. In PEDSnet, adjusted logistic regression indicated significantly lower likelihood of GD diagnosis among patients whose electronic medical record-reported sex was male and among patients who identified as Asian, Black/African American, and Hispanic/Latino/a/x/e. In contrast, in the YRBS sample, only youth whose sex was male had a lower likelihood of transgender identity. CONCLUSIONS: GDY are underrepresented in health system data, particularly those whose electronic medical record-reported sex is male, and Asian, Black/African American, and Hispanic/Latino/a/ x/e youth. Collecting more accurate gender identity information in health systems and surveys may help better understand the health-related needs and experiences of GDY and support the development of targeted interventions to promote more equitable care provision.",

author = "Kahn, {Nicole F.} and Sequeira, {Gina M.} and Asante, {Peter G.} and Kidd, {Kacie M.} and Coker, {Tumaini R.} and Christakis, {Dimitri A.} and Baer Karrington and Tandy Aye and Conard, {Lee Ann E.} and Nadia Dowshen and Kazak, {Anne E.} and Leena Nahata and Nokoff, {Natalie J.} and Voss, {Raina V.} and Richardson, {Laura P.}",

note = "Publisher Copyright: {\textcopyright} 2024 by the American Academy of Pediatrics.",

year = "2024",

month = jun,

day = "1",

doi = "10.1542/peds.2023-065197",

language = "English (US)",

volume = "153",

journal = "Pediatrics",

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T1 - Estimating Transgender and Gender- Diverse Youth Populations in Health Systems and Survey Data

AU - Kahn, Nicole F.

AU - Sequeira, Gina M.

AU - Asante, Peter G.

AU - Kidd, Kacie M.

AU - Coker, Tumaini R.

AU - Christakis, Dimitri A.

AU - Karrington, Baer

AU - Aye, Tandy

AU - Conard, Lee Ann E.

AU - Dowshen, Nadia

AU - Kazak, Anne E.

AU - Nahata, Leena

AU - Nokoff, Natalie J.

AU - Voss, Raina V.

AU - Richardson, Laura P.

PY - 2024/6/1

Y1 - 2024/6/1

N2 - OBJECTIVES: To identify and examine demographic variation in estimates of gender-diverse youth (GDY) populations from the PEDSnet learning health system network and the Youth Risk Behavior Survey (YRBS). METHODS: The PEDSnet sample included 14- to 17-years-old patients who had $2 encounters at a member institution before March 2022, with at least 1 encounter in the previous 18 months. The YRBS sample included pooled data from 14- to 17-year-old in-school youth from the 2017, 2019, and 2021 survey years. Adjusted logistic regression models tested for associations between demographic characteristics and gender dysphoria (GD) diagnosis (PEDSnet) or selfreported transgender identity (YRBS). RESULTS: The PEDSnet sample included 392 348 patients and the YRBS sample included 270 177 youth. A total of 3453 (0.9%) patients in PEDSnet had a GD diagnosis and 5262 (1.9%) youth in YRBS self-identified as transgender. In PEDSnet, adjusted logistic regression indicated significantly lower likelihood of GD diagnosis among patients whose electronic medical record-reported sex was male and among patients who identified as Asian, Black/African American, and Hispanic/Latino/a/x/e. In contrast, in the YRBS sample, only youth whose sex was male had a lower likelihood of transgender identity. CONCLUSIONS: GDY are underrepresented in health system data, particularly those whose electronic medical record-reported sex is male, and Asian, Black/African American, and Hispanic/Latino/a/ x/e youth. Collecting more accurate gender identity information in health systems and surveys may help better understand the health-related needs and experiences of GDY and support the development of targeted interventions to promote more equitable care provision.

AB - OBJECTIVES: To identify and examine demographic variation in estimates of gender-diverse youth (GDY) populations from the PEDSnet learning health system network and the Youth Risk Behavior Survey (YRBS). METHODS: The PEDSnet sample included 14- to 17-years-old patients who had $2 encounters at a member institution before March 2022, with at least 1 encounter in the previous 18 months. The YRBS sample included pooled data from 14- to 17-year-old in-school youth from the 2017, 2019, and 2021 survey years. Adjusted logistic regression models tested for associations between demographic characteristics and gender dysphoria (GD) diagnosis (PEDSnet) or selfreported transgender identity (YRBS). RESULTS: The PEDSnet sample included 392 348 patients and the YRBS sample included 270 177 youth. A total of 3453 (0.9%) patients in PEDSnet had a GD diagnosis and 5262 (1.9%) youth in YRBS self-identified as transgender. In PEDSnet, adjusted logistic regression indicated significantly lower likelihood of GD diagnosis among patients whose electronic medical record-reported sex was male and among patients who identified as Asian, Black/African American, and Hispanic/Latino/a/x/e. In contrast, in the YRBS sample, only youth whose sex was male had a lower likelihood of transgender identity. CONCLUSIONS: GDY are underrepresented in health system data, particularly those whose electronic medical record-reported sex is male, and Asian, Black/African American, and Hispanic/Latino/a/ x/e youth. Collecting more accurate gender identity information in health systems and surveys may help better understand the health-related needs and experiences of GDY and support the development of targeted interventions to promote more equitable care provision.

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Estimating Transgender and Gender- Diverse Youth Populations in Health Systems and Survey Data

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