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Assessing Racial Inequalities in Gender-Affirming Surgery Access and Hospital-Level Experience
Peter Shamamian
*1, Daniel Y. Kwon
1, Olachi Oleru
1, Nargiz Seyidova
1, Rebecca Suydam
1, Elan Horesh
2, Peter J. Taub
11Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, Tenafly, NJ; 2Mount Sinai Center for Transgender Medicine and Surgery, New York, NY
Background: Racial and ethnic minority groups, as well as gender minorities seeking gender-affirming care and surgery have historically encountered difficulty with access to and experience with healthcare. The intersection of these two groups may result in deficient healthcare for patients of minority racial and ethnic groups seeking gender-affirming surgery. The present study evaluated differences in gender-affirming genital surgery experience by race.
Methods: The 2018-2021 Healthcare Utilization Project National Inpatient Survey was queried for gender-affirming genital surgeries. Demographic, inpatient safety, and hospital-level characteristics were collected. Results were stratified by race and evaluated for differences. Significance was set at P<0.05.
Results: A total of 4,605 patients were included in the study, 3,345 patients were identified as White (73%), 320 as Black/African American (7%), 485 as Hispanic/Latino (11%), and 110 as Asian/Pacific Islander (2%). Black patients had more pre-existing comorbidities than the overall cohort (3 vs. 4, IQR 4, P<0.001), and more Black and Hispanic/Latino patients reported a lower income level (P<0.001). Black patients experienced a higher rate of inpatient medical complications than the overall cohort (1% vs. 3%, P=0.004) and had a longer length of stay (3 vs. 5 days, P<0.001). Furthermore, the highest total charges were observed among Black patients ($130,873, IQR $119,235, P<0.001). Finally, compared to the overall cohort, Black patients experienced routine discharge less often (94% vs. 81%, P<0.001) and more often required a higher level of care upon discharge, such as home health care or transfer to another facility (6% vs. 17%, P<0.001).
Conclusion: While the healthcare population is becoming more diverse, healthcare disparities still exist among non-White individuals receiving gender-affirming genital surgery. The present data suggest that Black patients receiving gender-affirming genital surgery more often have more complicated hospital and discharge courses, resulting in higher total hospital charges.
Table 1. Demographics, hospital characteristics, and inpatient hospital course stratified by patient race.
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