Madeline C Frost1, John R Blosnich, Keren Lehavot, Jessica A Chen, Anna D Rubinsky, Joseph E Glass, Emily C Williams. 1. Department of Health Services, University of Washington School of Public Health, Seattle, WA (MCF, KL, ECW); Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle WA (MCF, KL, JAC, ADR, ECW); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA (JRB); Health Services Research & Development (HSR&D) Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA (JRB); Department of Psychiatry and Behavioral Science, University of Washington, Seattle, WA (KL, JAC); Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (ADR); Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA (JEG).
Abstract
OBJECTIVES: Transgender people-those whose gender identity differs from their sex assigned at birth-are at risk for health disparities resulting from stressors such as discrimination and violence. Transgender people report more drug use than cisgender people; however, it is unclear whether they have higher likelihood of drug use disorders. We examined whether transgender patients have increased likelihood of documented drug use disorders relative to cisgender patients in the national Veterans Health Administration (VA). METHODS: Electronic health record data were extracted for VA outpatients from 10/1/09 to 7/31/17. Transgender status and past-year documentation of drug use disorders (any, opioid, amphetamine, cocaine, cannabis, sedative, hallucinogen) were measured using diagnostic codes. Logistic regression models estimated odds ratios for drug use disorders among transgender compared to cisgender patients, adjusted for age, race/ethnicity and year. Effect modification by presence of ≥1 mental health condition was tested using multiplicative interaction. RESULTS: Among 8,872,793 patients, 8619 (0.1%) were transgender. Transgender patients were more likely than cisgender patients to have any drug use disorder (Adjusted Odds Ratio [aOR] 1.67, 95% confidence interval [CI] 1.53-1.83), amphetamine (aOR 2.22, 95% CI 1.82-2.70), cocaine (aOR 1.59, 95% CI 1.29-1.95), and cannabis (aOR 1.82, 95% CI 1.62-2.05) use disorders. There was no significant interaction by presence of ≥1 mental health condition. CONCLUSIONS: Transgender VA patients may have higher likelihood of certain drug use disorders than cisgender VA patients, particularly amphetamine use disorder. Future research should explore mechanisms underlying disparities and potential barriers to accessing treatment and harm reduction services faced by transgender people.
OBJECTIVES: Transgender people-those whose gender identity differs from their sex assigned at birth-are at risk for health disparities resulting from stressors such as discrimination and violence. Transgender people report more drug use than cisgender people; however, it is unclear whether they have higher likelihood of drug use disorders. We examined whether transgender patients have increased likelihood of documented drug use disorders relative to cisgender patients in the national Veterans Health Administration (VA). METHODS: Electronic health record data were extracted for VA outpatients from 10/1/09 to 7/31/17. Transgender status and past-year documentation of drug use disorders (any, opioid, amphetamine, cocaine, cannabis, sedative, hallucinogen) were measured using diagnostic codes. Logistic regression models estimated odds ratios for drug use disorders among transgender compared to cisgender patients, adjusted for age, race/ethnicity and year. Effect modification by presence of ≥1 mental health condition was tested using multiplicative interaction. RESULTS: Among 8,872,793 patients, 8619 (0.1%) were transgender. Transgender patients were more likely than cisgender patients to have any drug use disorder (Adjusted Odds Ratio [aOR] 1.67, 95% confidence interval [CI] 1.53-1.83), amphetamine (aOR 2.22, 95% CI 1.82-2.70), cocaine (aOR 1.59, 95% CI 1.29-1.95), and cannabis (aOR 1.82, 95% CI 1.62-2.05) use disorders. There was no significant interaction by presence of ≥1 mental health condition. CONCLUSIONS: Transgender VA patients may have higher likelihood of certain drug use disorders than cisgender VA patients, particularly amphetamine use disorder. Future research should explore mechanisms underlying disparities and potential barriers to accessing treatment and harm reduction services faced by transgender people.
Authors: John R Blosnich; George R Brown; Jillian C Shipherd Phd; Michael Kauth; Rebecca I Piegari; Robert M Bossarte Journal: Am J Public Health Date: 2013-08-15 Impact factor: 9.308
Authors: Alexander W M Luther; Shannon V Reaume; Rana A Qadeer; Kara Thompson; Mark A Ferro Journal: Addict Behav Date: 2020-06-23 Impact factor: 3.913
Authors: Michelle M Johns; Richard Lowry; Jack Andrzejewski; Lisa C Barrios; Zewditu Demissie; Timothy McManus; Catherine N Rasberry; Leah Robin; J Michael Underwood Journal: MMWR Morb Mortal Wkly Rep Date: 2019-01-25 Impact factor: 17.586
Authors: Olivia V Fletcher; Jessica A Chen; Jenna van Draanen; Madeline C Frost; Anna D Rubinsky; John R Blosnich; Emily C Williams Journal: SSM Popul Health Date: 2022-06-28