Disparities in Suicidality by Gender Identity Among Medicare Beneficiaries

Introduction Suicidality is higher for gender minorities than the general population, yet little is known about suicidality in disabled or older adult gender minorities. Methods This study used 2009–2014 Medicare claims to identify people with gender identity–related diagnosis codes (disabled, n=6,678; older adult, n=2,018) and compared their prevalence of suicidality with a 5% random non–gender minority beneficiary sample (disabled, n=535,801; older adult, n=1,700,008). Correlates of suicidality were assessed (via chi-square) for each of the 4 participant groups separately, and then disparities within eligibility status (disabled or older adult) were assessed using logistic regression models, adjusting first for age and mental health chronic conditions and then additionally for Medicaid eligibility, race/ethnicity, or U.S. region (each separately). The primary hypotheses were that gender minority beneficiaries would have higher suicidality but that suicidality disparities would persist after adjusting for covariates. Data were analyzed between 2017 and 2019. Results Gender minority beneficiaries had higher unadjusted suicidality than non–gender minority beneficiaries in the disabled cohort (18.5% vs 7.1%, p Conclusions Heightened suicidality among identified gender minority Medicare beneficiaries highlights a pressing need to identify and reduce barriers to wellness in this population.