John R Blosnich1, Mary C Marsiglio2, Melissa E Dichter3, Shasha Gao4, Adam J Gordon5, Jillian C Shipherd6, Michael R Kauth7, George R Brown8, Michael J Fine9. 1. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: john.blosnich@va.gov. 2. VA Portland Health Care System, Portland, Oregon. 3. Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania. 4. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. 5. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; MIRECC, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. 6. LGBT Program Office of Patient Care Services, Department of Veterans Affairs, Washington, District of Columbia; VA Boston Healthcare System, National Center for PTSD, Women's Health Sciences Division, Boston, Massachusetts; Department of Psychiatry, Boston University, Boston, Massachusetts. 7. LGBT Program Office of Patient Care Services, Department of Veterans Affairs, Washington, District of Columbia; South Central MIRECC, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas. 8. Department of Psychiatry and Behavioral Sciences, East Tennessee State University, Johnson City, Tennessee; Mountain Home VA Medical Center, Mountain Home, Tennessee. 9. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Abstract
INTRODUCTION: Transgender individuals experience pronounced disparities in health (e.g., mood disorders, suicide risk) and in the prevalence of social determinants of housing instability, financial strain, and violence. The objectives of this study were to understand the prevalence of social determinants among transgender veterans and assess their associations with medical conditions. METHODS: This project was a records review using administrative data from the U.S. Department of Veterans Affairs databases for 1997-2014. Transgender veterans (N=6,308) were defined as patients with any of four ICD-9 diagnosis codes associated with transgender status. Social determinants were operationalized using ICD-9 codes and Department of Veterans Affairs clinical screens indicating violence, housing instability, or financial strain. Multiple logistic regression was used to assess the associations of social determinants with medical conditions: mood disorder, post-traumatic stress disorder, alcohol abuse disorder, illicit drug abuse disorder, tobacco use disorder, suicidal risk, HIV, and hepatitis C. RESULTS: After adjusting for sociodemographic variables, housing instability and financial strain were significantly associated with all medical conditions except for HIV, and violence was significantly associated with all medical conditions except for tobacco use disorder and HIV. There was a dose response-like relationship between the increasing number of forms of social determinants being associated with increasing odds for medical conditions. CONCLUSIONS: Social determinants are prevalent factors in transgender patients' lives, exhibiting strong associations with medical conditions. Documenting social determinants in electronic health records can help providers to identify and address these factors in treatment goals. Published by Elsevier Inc.
INTRODUCTION: Transgender individuals experience pronounced disparities in health (e.g., mood disorders, suicide risk) and in the prevalence of social determinants of housing instability, financial strain, and violence. The objectives of this study were to understand the prevalence of social determinants among transgender veterans and assess their associations with medical conditions. METHODS: This project was a records review using administrative data from the U.S. Department of Veterans Affairs databases for 1997-2014. Transgender veterans (N=6,308) were defined as patients with any of four ICD-9 diagnosis codes associated with transgender status. Social determinants were operationalized using ICD-9 codes and Department of Veterans Affairs clinical screens indicating violence, housing instability, or financial strain. Multiple logistic regression was used to assess the associations of social determinants with medical conditions: mood disorder, post-traumatic stress disorder, alcohol abuse disorder, illicit drug abuse disorder, tobacco use disorder, suicidal risk, HIV, and hepatitis C. RESULTS: After adjusting for sociodemographic variables, housing instability and financial strain were significantly associated with all medical conditions except for HIV, and violence was significantly associated with all medical conditions except for tobacco use disorder and HIV. There was a dose response-like relationship between the increasing number of forms of social determinants being associated with increasing odds for medical conditions. CONCLUSIONS: Social determinants are prevalent factors in transgender patients' lives, exhibiting strong associations with medical conditions. Documenting social determinants in electronic health records can help providers to identify and address these factors in treatment goals. Published by Elsevier Inc.
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