Characterizing Healthcare Disparities, Utilization, and Trends of Inflammatory Bowel Disease in Transgender and...

Transgender and nonbinary (TGNB) individuals comprise 0.5% to 0.6% of the U.S. population and face significant healthcare disparities, yet little is known about inflammatory bowel disease (IBD) in this group. We aimed to characterize IBD prevalence, comorbidities, healthcare utilization, and the impact of hormone replacement therapy (HRT) in TGNB individuals.

Using TriNetX, we analyzed (1) IBD prevalence among TGNB adults, (2) comparisons of IBD patients who are and who are not TGNB, and (3) comparisons of TGNB IBD patients with and without HRT. Outcomes included demographics, comorbidities, laboratory markers, healthcare encounters, IBD treatment, and cardiovascular and thrombotic events.

Of 111 227 TGNB patients, prevalence of Crohn's disease and ulcerative colitis was 0.508% and 0.448%, respectively, increasing with age. TGNB patients were younger (32.5 years of age vs 46.9 years of age; P < .001), exhibited higher rates of gastrointestinal and psychiatric comorbidities, and had more outpatient, emergency, and hospital visits, yet they underwent fewer endoscopies (25.7% vs 30.7% risk; P = .011) and were less likely to receive targeted IBD therapy than cisgender patients. Patients with HRT had more outpatient encounters (66.7% vs 58.2%; P = .010) and were more likely to use therapies like mesalamine (12.4% vs 7.6%; P = .021) than those without HRT. There were no significant differences in laboratory markers or thrombotic or cardiovascular events in these analyses.

TGNB IBD patients experience greater gastrointestinal and psychiatric comorbidities and receive fewer interventions overall despite greater healthcare contact. HRT was not associated with worsening disease or complications. These findings highlight critical disparities and the need for further research in this population.