UBC Theses and Dissertations
Epidemiology of chronic disease and multimorbidity for transgender people living with and without HIV Rich, Ashleigh
Introduction: Given limited evidence of the epidemiology of chronic disease and multimorbidity for transgender people living with and without HIV, the purpose of this dissertation was to: 1) systematically review chronic disease burden for transgender populations globally; 2) assess methods for identifying transgender people with and without HIV in administrative data, to facilitate investigation of chronic disease-related and other healthcare utilization for this population; and 3) investigate multimorbidity burden for transgender compared to cisgender people living with HIV. Methods: Systematic review methods were used to review and narratively synthesize the empirical literature on chronic disease among transgender populations, globally. Healthcare records were used to develop and validate a computable phenotype to identity transgender people in a large linked provincial administrative dataset. Longitudinal analysis methods were used to examine multimorbidity prevalence and incidence for transgender compared to cisgender people in North America in a large longitudinal HIV cohort collaborative. Key Findings: The literature on chronic disease among transgender populations is focused on mental and sexual health, with sparse attention to chronic physical health, in particular age-related chronic conditions and inflammation-related disease. Identification of transgender people is feasible in administrative health data, with high specificity, concordance with transgender-specific healthcare utilization, and ability to reliably characterize transgender populations in terms of demographics and chronic disease. Transgender people living with HIV had elevated incidence and prevalence of multimorbidity compared to cisgender people living with HIV, though inconsistently over time and without strong evidence of statistically significant differences by gender identity. Conclusions: High quality evidence of chronic conditions among transgender populations is needed; in particular longitudinal, population-based and representative studies with appropriate comparison groups and rigorous measurement of both transgender status and chronic conditions. Development of validated measures for ascertaining transgender status in administrative data is an important contribution given the limited evidence and the methodological challenges in transgender health research. Given evidence of increased burden of multimorbidity for transgender people living with HIV, future research on chronic co- and multimorbidity for transgender populations is warranted with attention to vulnerabilities by racialization and gender, and the role of intervenable disease risk factors such as smoking.
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