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

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 nonHispanic White. These two groups were compared to determine 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=1.042.19, 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=1.656.93, p<0.001), seriousmental illness (AOR=1.35, CI=1.091.68, 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), hypercholesterolemia (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 veterans' odds of having a history of incarcerationwas 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 transgender veterans. The odds of Black transgender veterans to live in a rural area was 65 % less than that of White transgender 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 retrospectivemedical chart data. Black transgender veterans were found to have a greater likelihood of social disadvantage and prevalence of severalmental andmedical 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.