Characteristics of COVID-19 in transgender people

PROJECT SUMMARY/ABSTRACT Transgender people may be disproportionally affected by the coronavirus infection disease 2019 (COVID-19) pandemic because they may face barriers to timely care and because of the possible effect of gender-affirming HT on COVID-19 disease severity. Based on these considerations, the overall goal of the proposed administrative supplement will be to collect and analyze additional data to characterize the COVID-19 epidemic in different subgroups of STRONG cohort members relative to matched cisgender controls. The proposed administrative supplement will include additional data collection for the ongoing parent project "An expanded national cohort study of transgender people" (R01AG066956). The five-year parent project, which is now in its second year, represents an expansion of the previously established Study of Transition, Outcomes and Gender (STRONG). STRONG is a cohort of transgender people enrolled in Kaiser Permanente (KP) integrated health care plans in Georgia, Northern California, Southern California, and the Mid-Atlantic States. The expanded cohort includes approximately 40,000 transgender persons matched with 800,000 male and female cisgender referents. We will use additional STRONG data to compare rates and types of COVID- 19 vaccination in transmasculine (TM) and transfeminine (TF) persons to cisgender controls, examine the incidence of the disease among transgender and cisgender individuals and investigate if transgender status, receipt of hormone therapy, and levels of hormones, play a role in COVID-19 severity. A unique feature of the proposed analysis is that it considers both the biological variable of sex as well as the social, environmental, cultural, and behavioral factors that define gender - a distinction clearly outlined in the Trans-NIH Strategic Plan. 1