Availability of sexual orientation and gender identity (SOGI) information in a cohort of transgender and gender diverse people: An analysis of electronic health records

Cynthia N Ramirez; Michael Goodman; Kristine Magnusson; Wendy Leyden; Alexandra N Lea; Darios Getahun; Courtney McCracken; Suma Vupputuri; Lee Cromwell; Timothy L Lash; Oumaima Kaabi; Guneet K Jasuja; Michael J Silverberg

doi:10.1016/j.annepidem.2025.10.016

Availability of sexual orientation and gender identity (SOGI) information in a cohort of transgender and gender diverse people: An analysis of electronic health records

Ann Epidemiol. 2025 Dec:112:23-27. doi: 10.1016/j.annepidem.2025.10.016. Epub 2025 Oct 15.

Affiliations

¹ Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, USA. Electronic address: Cynthia.N1.Ramirez@kp.org.
² Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
³ Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, USA.
⁴ Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
⁵ Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA.
⁶ Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Washington, DC, USA.
⁷ Center for Health Optimization & Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA; Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.

Abstract

Purpose: Electronic health records (EHR) offer a unique opportunity to systematically collect sexual orientation and gender identity (SOGI) data. This study examined the prevalence and determinants of SOGI reporting in an EHR-based cohort of transgender and gender diverse (TGD) individuals.

Methods: We identified TGD people with and without SOGI documentation across four Kaiser Permanente health plans from January 1, 2022-2024. TGD status was determined through clinical notes, diagnostic codes, and SOGI data based on a previously established cohort. Factors associated with SOGI reporting were assessed using log-binomial regression, yielding prevalence ratios (PR) and the 95 % confidence intervals (CI).

Results: Among 23,060 TGD individuals, 71 % had SOGI documentation in the EHR. Reporting varied by sociodemographic and clinical characteristics. For example, compared to those < 20 years, SOGI reporting was higher for those aged 21-59 (PRs 1.10-1.21; 95 % CIs 1.06-1.24) and lower for those > 60 (0.93; 0.88-0.99). Documentation was slightly lower for those assigned male at birth (0.98; 0.97-1.00) and varied by race and ethnicity (e.g., Hispanic: 0.97; 0.95-0.99; Other: 1.02; 0.98-1.05 vs. White).

Conclusions: KP's EHRs captured SOGI data for over 70 % of TGD individuals, though more research is needed to understand factors associated with missing data not captured in structured fields.

Keywords: Electronic health records; Gender identity; Sexual orientation; Transgender.

MeSH terms

Adolescent
Adult
Cohort Studies
Electronic Health Records* / statistics & numerical data
Female
Gender Identity*
Humans
Male
Middle Aged
Sexual Behavior* / statistics & numerical data
Sexual and Gender Minorities* / statistics & numerical data
Transgender Persons* / statistics & numerical data
Young Adult

Grants and funding

R01 AG066956/AG/NIA NIH HHS/United States