Cohort profile: Study of Transition, Outcomes and Gender (STRONG) to assess health status of transgender people

BMJ Open - Tập 7 Số 12 - Trang e018121 - 2017
Virginia P. Quinn1, Rebecca Nash2, Enid M. Hunkeler3, Richard Contreras1, Lee Cromwell4, Tracy A. Becerra-Culqui1, Darios Getahun1, Shawn V. Giammattei5, Timothy L. Lash2, Andrea Millman6, Brandi Robinson4, Douglas Roblin7, Michael J. Silverberg6, Jennifer Slovis8, Vin Tangpricha9,10, Dennis Tolsma4, Cadence Valentine1, Kevin C. Ward2, Savannah Winter4, Michael Goodman2
1Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
2Department of Epidemiology Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
3Division of Research, Kaiser Permanente Northern California (emerita), Oakland, California, USA
4Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
5The Rockway Institute, Alliant International University, San Francisco, California, USA
6Division of Research, Kaiser Permanente Northern California, Oakland, California, USA;
7School of Public Health, Georgia State University, Atlanta, Georgia, USA
8The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
9Emory University School of Medicine, Atlanta, Georgia USA
10The Atlanta VA Medical Center, Atlanta, Georgia, USA

Tóm tắt

PurposeThe Study of Transition, Outcomes and Gender (STRONG) was initiated to assess the health status of transgender people in general and following gender-affirming treatments at Kaiser Permanente health plans in Georgia, Northern California and Southern California. The objectives of this communication are to describe methods of cohort ascertainment and data collection and to characterise the study population.ParticipantsA stepwise methodology involving computerised searches of electronic medical records and free-text validation of eligibility and gender identity was used to identify a cohort of 6456 members with first evidence of transgender status (index date) between 2006 and 2014. The cohort included 3475 (54%) transfeminine (TF), 2892 (45%) transmasculine (TM) and 89 (1%) members whose natal sex and gender identity remained undetermined from the records. The cohort was matched to 127 608 enrollees with no transgender evidence (63 825 women and 63 783 men) on year of birth, race/ethnicity, study site and membership year of the index date. Cohort follow-up extends through the end of 2016.Findings to dateAbout 58% of TF and 52% of TM cohort members received hormonal therapy at Kaiser Permanente. Chest surgery was more common among TM participants (12% vs 0.3%). The proportions of transgender participants who underwent genital reconstruction surgeries were similar (4%–5%) in the two transgender groups. Results indicate that there are sufficient numbers of events in the TF and TM cohorts to further examine mental health status, cardiovascular events, diabetes, HIV and most common cancers.Future plansSTRONG is well positioned to fill existing knowledge gaps through comparisons of transgender and reference populations and through analyses of health status before and after gender affirmation treatment. Analyses will include incidence of cardiovascular disease, mental health, HIV and diabetes, as well as changes in laboratory-based endpoints (eg, polycythemia and bone density), overall and in relation to gender affirmation therapy.

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BMJ Open

Tập 7 Số 12

e018121

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