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2023 HSR&D/QUERI National Conference Abstract

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1098 — Social Stressors and Health among Older Transgender and Gender Diverse Veterans

Lead/Presenter: Guneet Jasuja,  COIN - Bedford/Boston
All Authors: Jasuja GK (Center for Healthcare Organization & Implementation Research, Boston University School of Medicine), Reisman JI (Center for Healthcare Organization & Implementation Research) Rao SR (Boston University School of Public Health) Wolfe HL (Center for Healthcare Organization & Implementation Research, Boston University School of Public Health) Hughto JMW (Brown University School of Public Health) Reisner SL (Brigham and Women’s Hospital) Shipherd JC ((National Center for PTSD, LGBTQ+ Health Program, Boston University School of Medicine)

Objectives:
Health disparities in transgender and gender diverse (TGD) Veterans compared to cisgender Veterans have been documented. However, there is a paucity of literature on health disparities focused on older TGD Veterans. We compared health conditions and social stressors among older TGD Veterans to cisgender Veterans in the Veterans Health Administration (VHA).

Methods:
Using transgender-related diagnosis codes, we identified 1,244 TGD Veterans ?65 years of age receiving care in the VHA from 2006-2018. Three cisgender Veterans with encounters during the study period were randomly matched to each TGD veteran. Matching was based on 5-year age group, VHA site where the TGD veteran’s index transgender-related diagnosis was documented, and date of outpatient visit within ±1 day the date of the TGD veteran’s index transgender-related diagnosis resulting in 3,722 cisgender veterans. This matching strategy was employed to account for potential differences by site, region and time of care. Adjusted proportions (adjusted %) and associated 95% Confidence Intervals (CI) for health conditions and social stressors as a function of cohort (TGD vs. cisgender) was ascertained in multivariable logistic regression models. These models also adjusted for the clustering of patients within sites.

Results:
In adjusted models, a lower proportion of TGD Veterans compared to cisgender Veterans had alcohol use disorder [adjusted % (95% CI): 13.0% (11.2-15.0) vs. 17.6% (16.2-19.0)], drug use disorder [11.2% (9.5-13.0) vs. 17.5% (16.2-19.0) and tobacco use [35.1% (32.4-37.9) vs. 42.0% (40.2-43.9)]. However, TGD Veterans were more likely to experience depression [57.3% (54.5-60.1) vs. 45.1% (43.2-47.0)], individual social stressors (e.g., unemployment/financial issues [13.2% (11.4-15.3) vs. 5.3% (4.6-6.2)]), and military sexual trauma [9.3% (7.7-11.1) vs. 3.8% (3.2-4.6)]. Further, compared to cisgender Veterans, TGD Veterans were more likely to have a documented higher count of social stressors (1 or more stressor [42.2% vs. 18.9%]; 2 or more stressors [20.7% vs. 7.6%]; ?3 stressors [10.0% vs. 2.8%]). All p-values noted here < 0.0001.

Implications:
Despite significant disparities in social stressors compared to cisgender Veterans, TGD Veterans had lower proportion of alcohol use, tobacco use and drug use. Increased resilience and coping skills among the TGD Veterans compared to the cisgender Veterans might be contributing to this lower substance use among the TGD Veteran population. Greater understanding of the multi-level determinants of disparities in social stressors among older TGD Veterans will be an important next step to developing tailored interventions that alleviate social stressor challenges experienced by these TGD Veterans.

Impacts:
Detecting disparities is a necessary first step in the Health Disparities Research Framework, followed by an understanding of the multi-level determinants underlying the disparities to ultimately intervening to reducing or eliminating those disparities. This study focused on the first phase of detecting health disparities among TGD Veterans aged 65 years or older compared to matched cisgender Veterans.