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Impact of Social Determinants of Health on Medical Conditions Among Transgender Veterans

  • John R. Blosnich
    Correspondence
    Address correspondence to: John R. Blosnich, PhD, MPH, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive C (151C-U), Building 30, Pittsburgh PA 15240-1001
    Affiliations
    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
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  • Mary C. Marsiglio
    Affiliations
    VA Portland Health Care System, Portland, Oregon
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  • Melissa E. Dichter
    Affiliations
    Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
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  • Shasha Gao
    Affiliations
    Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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  • Adam J. Gordon
    Affiliations
    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
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  • Jillian C. Shipherd
    Affiliations
    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
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  • Michael R. Kauth
    Affiliations
    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
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  • George R. Brown
    Affiliations
    Department of Psychiatry and Behavioral Sciences, East Tennessee State University, Johnson City, Tennessee

    Mountain Home VA Medical Center, Mountain Home, Tennessee
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  • Michael J. Fine
    Affiliations
    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
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Published:February 01, 2017DOI:https://doi.org/10.1016/j.amepre.2016.12.019

      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.
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