Hospitalization Patterns, Outcomes, and Resource Utilization among Individuals with Gender Dysphoria: A Nationwide Study
Authors: Uwumiro Fidelis , Bojerenu Micheal , Obijuru Chinwendu , Oluwasemilore Okunlola , Nwike Vivian , Abdul Summayyah , Yeyehyirad Halleluya , Silvia Udegbe , Abesin Olawale , Orjih George 
Published: August 2023

Background

The significance of providing gender-affirming care has gained prominence in recent years. This study examines the hospitalization patterns of individuals with gender dysphoria, exploring the indications for hospitalization, types of gender-affirming care offered, resource utilization, and outcomes.

Methods

We analyzed 67,454 discharge records from the 2016-2020 Nationwide Inpatient Sample (NIS). We identified cases of gender dysphoria using the International Classification of Diseases, 10th Revision (ICD-10) code F64.0. Demographic data, co-morbidity scores, indications for hospitalization, care patterns, length of hospital stay, mortality rates, and hospital charges were rigorously examined using ICD-10 codes and survey techniques. The trend in hospital expenditures was assessed using the Cochran-Armitage test with statistical significance set at P<.05.

Results

About 53.6% were assigned female at birth, 46.4% male. The mean age was 33 ± 0.2 years. White Americans constituted 67.3%, Blacks 14.9%, Hispanics 10%, and Asians/Pacific Islanders 2.1%. Most admissions (51.6%) were ages 16-35, with 9.5% aged 60 or older. Mental health services (55.2%) and cross-sex hormonal therapy (48.8%) were common. Gender-affirming surgeries were performed in 7.1% of cases, while 0.4% received puberty-suppressing therapy. About 355 mortalities were recorded. Mortality rates increased with advancing age, with the highest mortality among individuals over 60 years old (205). No deaths occurred among those who received gender-affirming surgery. The mean length of hospital stay (LOS) was 6 days. Patients in the age range of 5 to 15 years had longer hospital stays compared to other age groups, with a mean LOS of 7.3 ± 0.2 days (P<0.001). Total hospital costs for gender-affirming care exceeded $3.3 billion, with a notable trend of increasing costs over the study period. The average costs for gender-affirming surgery, mental health services, and cross-sex hormone therapy were $101,349 ± $5,881, $41,938 ± $1,350, and $70,873 ± $13,528, respectively. Over time, mean and total costs for gender dysphoria hospitalizations increased from 400 million in 2016 to 1.3 billion in 2020 (Ptrend<0.001).

Conclusion

This study reinforces the critical role of mental health services and cross-sex hormonal therapy in gender transition. It also challenges stereotypes by demonstrating that gender-affirming surgeries are sought by individuals across a wide age spectrum. However, it underscores the importance of addressing healthcare disparities, particularly for older individuals. The substantial financial costs associated with gender-affirming care underscore its significance and increasing demand. These findings emphasize the evolving healthcare needs of the gender dysphoria population, necessitating ongoing research and comprehensive support to advance gender-affirming care and understanding.