Evidence map›Paper›PMID 42329493›Full record

Observational studyQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation2026

Understanding determinants of patient-reported outcome measure non-response among transgender and gender diverse individuals: an intersectional multilevel analysis of sociodemographic and structural vulnerabilities.

Manraj N Kaur, Mahima Jain, Tanujit Dey, Dany T Huerta, Peter Meyers, Chengbo Zeng, Brittany M Dragonetti, Marc R DeAngelo, Calvin Schuster, Mohammad Naser Lessani and 3 more

Abstract readObservational Study
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Observational study in Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

13 authors.

Manraj N KaurPatient-Reported Outcomes and Values & Experience Center (PROVE), Department of Surgery, Mass General Brigham, Harvard Medical School, 75 Francis Street, Boston, MA, 02116, USA. mkaur17@bwh.harvard.edu.ORCID http://orcid.org/0000-0002-1911-0395
Mahima JainCenter for Surgery and Public Health, Department of Surgery, Mass General Brigham, Harvard Medical School, Boston, MA, 02115, USA.
Tanujit DeyCenter for Surgery and Public Health, Department of Surgery, Mass General Brigham, Harvard Medical School, Boston, MA, 02115, USA.
Dany T HuertaPatient-Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
Peter MeyersOffice of the Chief Medical Officer, Mass General Brigham, Boston, MA, 02145, USA.
Chengbo ZengPatient-Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
Brittany M DragonettiOffice of the Chief Medical Officer, Mass General Brigham, Boston, MA, 02145, USA.
Marc R DeAngeloOffice of the Chief Medical Officer, Mass General Brigham, Boston, MA, 02145, USA.
Calvin SchusterPatient-Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
Mohammad Naser LessaniGeoinformation and Big Data Research Laboratory, Department of Geography, The Pennsylvania State University, University Park, PA, 16802, USA.
Zhenglong LiGeoinformation and Big Data Research Laboratory, Department of Geography, The Pennsylvania State University, University Park, PA, 16802, USA.
Andrea PusicDivision of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, 75 Francis S, Boston, MA, 02116, USA.
Maria EdelenPatient-Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposePatient-reported outcome measures (PROMs) are increasingly integrated into routine clinical care and value-based accountability frameworks, yet systematic non-response may exclude structurally marginalized populations, including transgender and gender diverse (TGD) individuals. This study examined individual- and neighborhood-level predictors of non-response to the PROMIS Global Health (PROMIS-10) questionnaire among TGD individuals using an intersectional multilevel framework.

methodsWe conducted an observational cohort study used electronic health record data from 2015 to 2023 within a large U.S. healthcare system. TGD adults (≥18 years) assigned the PROMIS-10 during clinical encounters were included. PROM non-response was defined as a questionnaire assigned but not completed. Multivariable regression evaluated sociodemographic predictors, and multilevel analysis of individual heterogeneity and discriminatory accuracy quantified variance across intersectional strata. Structural predictors included segregation (Delta Index) and Social Vulnerability Index (SVI).

resultsNon-response at encounter level was high among 7528 TGD patients (85.8%; 95% CI 84.2-87.4). Older age (≥ 36 years; β = 3.3; 95% CI 1.12-5.50) and lower educational attainment (β = 3.23; 95% CI 1.05-5.41) were associated with increased non-response, while insurance type was not associated and ethno-racial identity showed a small, non-significant increase after adjustment. Intersectional strata explained only 1% of variance in non-response, decreasing to 0.3% after adjustment. Higher segregation (Delta Index; β = 10; 95% CI 4.0-17.0) and residence in the highest vulnerability areas (SVI > 0.75; β = 7.9; 95% CI 0.6-15.0) predicted greater non-response.

conclusionsPROM non-response among TGD individuals reflects individual and structural inequities. Equity-centered PROM implementation strategies are needed to prevent systematic exclusion from outcome-based evaluation.

Indexed as

Patient Reported Outcome MeasuresTransgender PersonsAdolescentAdultCohort StudiesFemaleGender-Nonconforming PersonsHumansMaleMiddle AgedMultilevel AnalysisSocial VulnerabilitySociodemographic FactorsSocioeconomic Disparities in HealthSocioeconomic FactorsSurveys and QuestionnairesGender diverseMultilevel modelingNon-responsePROMResponse ratesSocial determinants of healthTransgender

Identifiers

PMID42329493

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.