Nathaniel M. Tran
I use a variety of data to
contextualize & identify solutions
to address health and social inequities.
COSMOS
COllecting Sexual orientation/gender identity in Mid-life and Older Adults Study (COSMOS)
I lead COSMOS, a project that examines if and how people share sensitive information such as LGBTQ+ identity with the government, from local health centers to federal agencies. This work is motivated by the fact that LGBTQ+ people experience significant financial and discrimination-related barriers to health care. Collection and ethical use of LGBTQ+ identity can help us ensure health systems treat LGBTQ+ fairly, including getting access to timely appointments, matching patients with providers who have LGBTQ+ clinical and cultural competencies, and improving adherence to high-value preventive services like vaccinations and cancer screenings.
Baseline results from COSMOS were published in the Journal of the American Medical Association (JAMA), where we found that only 7 state Medicaid programs collect demographic data elements such as sex, sexual orientation, or gender identity (SOGI) that is inclusive of LGBTQ+ enrollees. The Centers for Medicare and Medicaid Services have released new SOGI data modules that could be asked of the nearly 100 million Medicaid, CHIP, and Marketplace enrollees as a key step to advance LGBTQ+ health equity.
Selected Research publications
In this study published by Health Affairs, we found that lesbian, gay, and bisexual adults skip or delay medical care because of cost more frequently than their heterosexual peers. Financial barriers to medical care were even higher for gay, lesbian, and bisexual adults enrolled in high-deductible health plans, both compared to straight adults on similar high-deductible plans, and gay, lesbian, and bisexual adults with other private insurance.
In this study published by the American Journal of Preventive Medicine, we found that LGBTQ+ patients with affirming providers (doctors, NPs, PAs) had better preventive care (flu shot, cancer screenings, HIV testing) and chronic disease (mental health condition) outcomes than those with non-affirming providers. Health systems can participate in the Healthcare Equality Index to improve their LGBTQ+ cultural competency.
In this study published by JAMA Psychiatry, we found that lesbian, gay, bisexual, and other queer adults reported higher odds of all adverse childhood experiences (ACE) compared to heterosexual adults, with the largest disparity in emotional and sexual abuse. ACE exposure associated with poorer mental health in adulthood. LGBQ+ youth need additional protections in school, public, and at home to reduce the lifelong consequences of ACE.
In this study published by Preventive Medicine, we found that transgender and gender diverse adults reported higher prevalence of all 8 types of adverse childhood experiences (ACE) assessed, with much higher rates of emotional and physical abuse. Transgender and gender diverse adults were more likely to report intense exposure to ACEs, and greater penalties to mental health in adulthood as the level of exposure to ACEs increased.
In this study published by Transgender Health, we found wide variation in the social, legal, and medical steps taken by transgender and gender non-binary adults in establishing congruence with their gender identity. Professionals working with transgender people should be aware and respectful of the variation in desires for and use of different steps such as name change, updating legal IDs, and use of hormone therapy.
In this study published by JHPPL, we found that transgender people living in states with more comprehensive gender identity legal protections (e.g. non-discrimination policies in the workplace, school, healthcare) had better mental health than transgender people in states without these protections. National non-discrimination policies such as the proposed The Equality Act may improve transgender population health.