Racial Health Disparities in a Cohort of 5,135 Transgender Veterans

Abstract

Objective There are no large-scale studies of racial health disparities in transgender patients. The Veterans Health Administration (VHA) is the largest health-care system in the United States and was an early adopter of electronic health records. We present new data on medical and mental health disparities in a large population of transgender veterans. Method Using four ICD-9-CM codes, we identified a cohort of transgender veterans who presented for VHA care from1996–2013. A total of 5,135 transgender veterans were identified, 387 were non-Hispanic Black and 4,120 were non- Hispanic White. These two groups were compared to deter- mine if medical and/or mental health disparities existed. Results Black transgender veterans had increased odds to be diagnosed with alcohol abuse (adjusted odds ratio [AOR]= 1.86, 95 % confidence interval [CI] = 1.50–2.31, p < 0.0001), benign prostatic hyperplasia (AOR = 1.36, CI = 1.01–1.84, p < 0.05), congestive heart failure (AOR = 1.51, CI = 1.04– 2.19, p < 0.05), HIV/AIDS (AOR = 6.77, CI = 4.60–9.97, p < 0.0001), hypertension (AOR = 1.71, CI = 1.34–2.17, p < 0.0001), end-stage renal disease (AOR = 3.34, CI = 1.65– 6.93, p<0.001), serious mental illness (AOR=1.35, CI=1.09– 1.68, p<0.01), and tobacco use (AOR=1.29, CI=1.04–1.59, p<0.05). However, the odds of Black transgender veterans to be diagnosed with the following conditions were reduced: depression (AOR = 0.73, CI = 0.58–0.93, p < 0.01), hypercholes- terolemia (AOR = 0.71, CI = 0.57–0.89, p < 0.01), and obesity (AOR = 0.79, CI = 0.63–0.98, p < 0.05). Black transgender vet- erans’ odds of having a history of incarceration was nearly three times larger (AOR = 2.91, CI = 1.84–4.62, p < 0.0001) and their odds of experiencing homelessness was nearly two times larger (AOR = 1.85, CI = 1.49–2.31, p < 0.0001) than White transgen- der veterans. The odds of Black transgender veterans to live in a rural area was 65 % less than that of White trans- gender veterans (AOR = 0.35, CI = 0.27–0.46, p < 0.0001). Conclusions This is the first study to examine a large cohort of transgender patients for the presence of racial disparities in psychiatric and medical health outcome disparities using ret- rospective medical chart data. Black transgender veterans were found to have a greater likelihood of social disadvantage and prevalence of several mental and medical conditions compared to White transgender veterans. Racial disparities occurred in a context of global health disparities in transgender veterans, as a group, compared to non-transgender veterans. These findings may have implications for policy, prevention strategies, and health-care delivery in VA and other health-care systems.