A Novel Method for Estimating Transgender Status Using Electronic Medical Records
PURPOSE:
We
describe a novel algorithm for identifying transgender people and determining
their male-to-female (MTF) or female-to-male (FTM) identity in electronic
medical records of an integrated health system.
METHODS:
A
computer program scanned Kaiser Permanente Georgia electronic medical records
from January 2006 through December 2014 for relevant diagnostic codes, and
presence of specific keywords (e.g., "transgender" or
"transsexual") in clinical notes. Eligibility was verified by review
of de-identified text strings containing targeted keywords, and if needed, by
an additional in-depth review of records. Once transgender status was
confirmed, FTM or MTF identity was assessed using a second program and another
round of text string reviews.
RESULTS:
Of
813,737 members, 271 were identified as possibly transgender: 137 through
keywords only, 25 through diagnostic codes only, and 109 through both codes and
keywords. Of these individuals, 185 (68%, 95% confidence interval [CI]:
62%-74%) were confirmed as definitely transgender. The proportions (95% CIs) of
definite transgender status among persons identified via keywords, diagnostic
codes, and both were 45% (37%-54%), 56% (35%-75%), and 100% (96%-100%). Of the
185 definitely transgender people, 99 (54%, 95% CI: 46%-61%) were MTF, 84 (45%,
95% CI: 38%-53%) were FTM. For two persons, gender identity remained unknown.
Prevalence of transgender people (per 100,000 members) was 4.4 (95% CI:
2.6-7.4) in 2006 and 38.7 (95% CI: 32.4-46.2) in 2014.
CONCLUSIONS:
The
proposed method of identifying candidates for transgender health studies is low
cost and relatively efficient. It can be applied in other similar health care
systems.
By: Roblin D1, Barzilay J2, Tolsma D2, Robinson B2, Schild L2, Cromwell L2, Braun H3, Nash R3, Gerth J4, Hunkeler E5, Quinn VP6, Tangpricha V7, Goodman M8.
- 1School of Public Health, Georgia State University, Atlanta; Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta.
- 2Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta.
- 3Rollins School of Public Health, Emory University, Atlanta, GA.
- 4Emory College of Arts and Sciences, Atlanta, GA.
- 5Division of Research, Kaiser Permanente, Oakland, CA.
- 6Kaiser Permanente Southern California, Pasadena.
- 7Emory University, School of Medicine, Atlanta, GA; The Atlanta VA Medical Center, Atlanta, GA.
- 8Rollins School of Public Health, Emory University, Atlanta, GA. Electronic address: mgoodm2@emory.edu.
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