Health Services/Policy
Preventable Healthcare Encounters in Transgender and Non-Transgender Adults at an Integrated Health System. Cynthia N. Ramirez* Cynthia N. Ramirez Ramirez Ramirez Ramirez Ramirez Ramirez Kaiser Permanente Northern California Division of Research
Purpose: Preventable healthcare encounters (PHE) are defined as avoidable hospitalizations and emergency department visits for conditions that can be effectively managed in outpatient care. Transgender and gender diverse (TGD) patients may face elevated risk for PHE due to care disruptions, stigma, and higher rates of mental health and substance use conditions. However, PHE have not been examined in TGD compared with non‑TGD patients.
Methods: We conducted a cross‑sectional analysis in a matched cohort of TGD and non‑TGD adults at Kaiser Permanente Northern California from January 1, 2023, to December 31, 2024. PHE were identified using a validated metric developed by the Agency for Healthcare Research and Quality for measuring ambulatory care-sensitive conditions, which examines PHE for seven conditions: diabetes, chronic obstructive pulmonary disease, hypertension, heart failure, pneumonia, urinary tract infection, and asthma. Associations between TGD status and PHE (any vs none) were evaluated using prevalence ratios (PRs) estimated from modified Poisson regression, sequentially adjusting for sociodemographic factors, primary care engagement, clinical comorbidities, and mental health and substance use conditions.
Results: Among 7,181 TGD and 121,188 non-TGD adults, PHE prevalence was higher among TGD patients (6% vs. 4%). TGD patients had higher unadjusted prevalence of PHE (PR = 1.52; 95% CI, 1.38–1.68), which remained elevated after adjustment for sociodemographic factors, primary care engagement, and clinical comorbidities (PR = 1.24; 95% CI, 1.12–1.36). After additional adjustment for mental health and substance use conditions, the association was attenuated (PR = 1.10; 95% CI, 1.00–1.21).
Conclusion: TGD patients experience a higher prevalence of PHE overall, but this appears to be explained by diagnosis of mental health and substance use conditions. Efforts to reduce PHE among TGD patients may benefit from integrating mental health and substance use services within affirming outpatient care.
