PROJECT SUMMARY Health disparities and barriers to health care for gender minorities (i.e., transgender, gender non-conforming, non-binary, intersex individuals, and other minority gender identities) have been identified and targeted for elimination by numerous organizations and agencies, including the National Institutes of Health. A growing body of research indicates that gender minorities experience widespread discrimination and stigma in various contexts (e.g., health care, employment, housing, public accommodations, and education) — which negatively affects their physical, mental, behavioral, and social health. More concerning is the absence of robust data collection efforts needed to monitor the health needs of gender minority (GM) populations in the United States. The goal of this project is to develop the world’s largest cohort of gender minority (GM) patients using private health insurance claims data that contains more than 33 billion claim records and over 150 million covered lives in the United States. Using data from FAIR Health (a repository of private insurance claims submitted by over 60 national and regional payors and third-party administrators), this project will identify, describe, and compare health outcomes, health services utilization, and the social determinants of health between a matched cohort of GM and non-GM patients. We will also evaluate correlations between state policy environments and health disparities between GM and non-GM patients in FAIR Health data. Finally, we will identify a longitudinal cohort of GM and non-GM individuals to follow over time. This project will lead to new discoveries in understanding health outcomes, health services utilization, and the social determinants of health for GM people in the United States.

PROJECT NARRATIVE & PUBLIC HEALTH RELEVANCE Health disparities and barriers to medical care for gender minorities (transgender, gender non-conforming, non-binary, intersex individuals, and other minority gender identities) have been targeted for elimination by the National Institutes of Health (NIH), the National Academy of Medicine, and Healthy People 2030 Goals. The absence of robust data collection on gender minorities has precluded and stalled the scientific evidence on gender minority health. This project overcomes issues of small sample sizes and will create the world’s largest cohort of gender minority individuals, which will significantly advance the scientific knowledge of gender minority health.