Geographic Differences in Patient Demographics and Performance of Gender-Affirming Surgery From 2016 to 2019

Area of Science:

• Health Services Research
• Socioeconomic Determinants of Health
• Surgical Outcomes

Background:

• Legislation has improved insurance coverage for gender-affirming surgery (GAS).
• However, recent bills criminalizing GAS providers threaten patient care, particularly in the South and Midwest.
• Understanding regional variations in GAS is crucial for equitable healthcare access.

Purpose of the Study:

• To examine how US census region influences patient demographics for GAS.
• To analyze regional differences in GAS rates within the ambulatory surgery setting.
• To identify potential disparities in care based on geographic location.

Main Methods:

• Analysis of the Nationwide Ambulatory Surgery Sample (NASS) from 2016-2019.
• Identification of individuals with gender dysphoria undergoing GAS using billing codes.
• Stratification of demographic and clinical characteristics by US census region.

Main Results:

• Overall GAS rates increased by 187% between 2016 and 2019.
• The Midwest region showed the highest GAS increase (257%), followed by the Northeast (203%) and South (218%).
• Patients outside the West region had higher odds of anxiety/depression and lower incomes.

Conclusions:

• Substantial growth in GAS occurred in the Midwest, South, and Northeast from 2016-2019.
• Observed regional differences in insurance coverage, socioeconomic status, and comorbidities.
• These findings highlight the need to address regional disparities in GAS access and outcomes.