Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case-Control Study
PURPOSE:
There
are no large controlled studies of health disparities in transgender (TG) or
gender dysphoric patients. The Veterans Health Administration (VHA) is the
largest healthcare system in the United States and was an early adopter of
electronic health records. We sought to determine whether medical and/or mental
health disparities exist in VHA for clinically diagnosed TG veterans compared
to matched veterans without a clinical diagnosis consistent with TG status.
METHODS:
Using
four ICD-9-CM codes consistent with TG identification, a cohort of 5135 TG
veterans treated in VHA between 1996 and 2013 was identified. Veterans without
one of these diagnoses were matched 1:3 in a case-control design to determine
if medical and/or mental health disparities exist in the TG veteran population.
RESULTS:
In 2013,
the prevalence of TG veterans with a qualifying clinical diagnosis was
58/100,000 patients. Statistically significant disparities were present in the
TG cohort for all 10 mental health conditions examined, including depression,
suicidality, serious mental illnesses, and post-traumatic stress disorder. TG
Veterans were more likely to have been homeless, to have reported sexual trauma
while on active duty, and to have been incarcerated. Significant disparities in
the prevalence of medical diagnoses for TG veterans were also detected for
16/17 diagnoses examined, with HIV disease representing the largest disparity
between groups.
CONCLUSION:
This
is the first study to examine a large cohort of clinically diagnosed TG
patients for psychiatric and medical health outcome disparities using
longitudinal, retrospective medical chart data with a matched control group. TG
veterans were found to have global disparities in psychiatric and medical
diagnoses compared to matched non-TG veterans. These findings have significant
implications for policy, healthcare screening, and service delivery in VHA and
potentially other healthcare systems.
- 1 Psychiatry Service, Mountain Home Veterans Affairs Medical Center , Johnson City, Tennessee.
- 2 Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University , Johnson City, Tennessee.
- 3 Office of Health Equity , Veterans Health Administration, Washington, District of Columbia.
- LGBT Health. 2016 Apr;3(2):122-31. doi: 10.1089/lgbt.2015.0058. Epub 2015 Dec 16.
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