Beyond the Binary: Analysis of Sickle Cell Disease Crisis Hospitalizations in the Transgender Population in United States

Introduction:

Transgender individuals have a gender identity that differs from their sex assigned at birth. In the United
States, more than 1.6 million adults identify as transgender, with 39% being women and 36% being men.
Although gender differences in disease prevalence are well documented, research on the prevalence
and outcomes of diseases such as sickle cell crisis among transgender individuals is limited. This study
aims to analyze the trends and outcomes of sickle cell crisis hospitalizations in the transgender
population compared to the general population.

Methods:

This was a retrospective analysis of data obtained from the Nationwide Inpatient Sample (NIS) database.
Data were sampled from 2012 to 2020 utilizing the ICD-10 codes for sickle cell crisis and included
patients over 18 years who identified as transgender. The primary outcome was in-hospital mortality.
Secondary outcomes were the length of stay and total hospital costs. Descriptive statistics summarized
demographic and clinical characteristics. Comparisons between transgender and cisgender patients
were made using t-tests and chi-square tests. A multivariate logistic regression analysis was used to
estimate the odds ratio for factors associated with increased inpatient mortality, including age, race,
median household income, region, hospital type, and hospital size.

Results:

This study examines the hospitalization outcomes of transgender patients experiencing sickle cell crisis
in the United States from 2012 to 2020, using data from the National Inpatient Sample (NIS) database.
During this period, 912,450 patients were admitted for sickle cell crisis, with 36,200 identified as
transgender. The mean age of transgender patients was 29 years, compared to 28 years in the general
population. Both groups were predominantly African American (72% vs. 70%), followed by Caucasian
(18% vs. 20%). Transgender individuals predominantly fell into the lower quartile for median household
income (34.5%), whereas 41% of cisgender patients were in the 26th-50th percentile, and 22% were in
the 51st-75th percentile. Inpatient mortality among transgender patients was 2.3 times higher than in
cisgender patients (95% CI: 1.4-3.7, p < 0.05). The average length of stay was 1.7 days longer for
transgender patients (95% CI: 1.0-2.4, p < 0.05). An increased length of stay was observed in teaching
hospitals by 1.9 days (95% CI: 1.2-2.6, p < 0.001) and in larger hospitals by 1.6 days (95% CI: 0.8-2.4, p <
0.001). The total cost of admission was significantly higher in teaching hospitals at $19,483 (95% CI:
$16,214 - $22,752, p < 0.001). Regionally, the Southern United States had the highest rate of
hospitalizations for transgender patients (45%), followed by the Northeastern (20%), Midwestern (15%),
and Western regions (10%). Multivariate logistic regression analysis revealed that increased age, African
American race, lower income, and admission to teaching or larger hospitals were significant predictors
of higher inpatient mortality among transgender patients.

Conclusion:

The study highlights significant disparities in hospitalization outcomes for transgender patients with
sickle cell crisis, including elevated inpatient mortality, extended hospital stays, and higher costs. These
findings underscore the necessity for customized healthcare strategies to address these inequities,
especially in teaching and larger hospitals.