PB0590 - Venous Thrombo-embolism in Transgender and Gender Non-Binary Adolescents: An Administrative Database Study

Background: A recent study conducted at Boston Children’s Hospital (BCH) showed that venous thromboembolism (VTE) is rare in transgender and gender non-binary (TNB) adolescents. Additionally, gender-affirming hormone-treatment (GAHT) was not found to be a significant risk factor for thrombosis in this cohort.

Aims: The principal objective of this investigation was to confirm our preliminary findings across 49 tertiary-care children’s hospitals in the United States (US).

Methods: Data were obtained from Pediatric Health Information System (PHIS), an administrative database of clinical/resource-utilization data from 49 tertiary-care children's hospitals in the US. ICD9/ICD10 codes were used to identify eligible subjects, defined as patients (birth-21 years) hospitalized with VTE between 1/1/2012-12/31/2021 at one of the 49-participating centers. ICD9/ICD10 codes for gender dysphoria were used to identify TNB patients. Mean (SD) or median (range) were calculated for continuous data, and frequency with 95% confidence interval for categorical data.

Results: During the study period, 39,503 unique patients were diagnosed with VTE. Mean age (SD) at VTE diagnosis was 7.7 (7.3) years. Only 23 (0.06%) patients had a diagnosis code for gender dysphoria. Among these 23 patients, the median (range) age at VTE diagnosis was 16.2 (11.6-20.5) years. Compared to the overall cohort, TNB patients with VTE were more likely to be female, white race, and/or obese (Table 1). Only 2/23 (8.7%) TNB patients with VTE had an ICD9/ICD10 code for GAHT. We have sought approval from the Institutional Review Board to de-identify patients from BCH enrolled in PHIS for internal-validation of these data.

Conclusion(s): These findings support our initial observation that VTE is rare in TNB adolescents, and typically occurs in the setting of additional risk-factors. Only 2/23 TNB patients had an ICD9/ICD10 code for GAHT, suggesting that it is unlikely that GAHT is a significant risk factor for VTE in this cohort. Internal-validation of these data is currently underway.