Racialized differences in the prevalence of drug use disorder among transgender Veterans

Abstract: Aim: Structural discrimination and racism (SDR) influences health outcomes, like substance use, for transgender individuals and those with minoritized racial/ethnic identities. Intersecting identities may compound this. We describe the prevalence of drug use disorder (DUD) across race/ethnicity among transgender Veterans Health Administration (VA) patients. Methods: We used national VA Electronic Health Record data for patients with outpatient visits (10/2009-7/2017) and documented (ICD-9/10) transgender identity. Logistic regression models were fit to estimate prevalence and 95% confidence interval of DUD (documented opioid, amphetamine, cocaine, hallucinogen, cannabis, and/or other stimulant/sedative disorder) for Black, Hispanic, White, and Other patients. Models were adjusted en bloc for potential sequelae of SDR: 1) demographics (age, urbanicity, census region) 2) socioeconomic (copay and housing status, economic hardship, incarceration) 3) mental health/other substance use (diagnostic) and 4) other chronic health conditions (HIV, Hepatitis C, outpatient utilization) (fully adjusted.) Results: Among 8,250 eligible patients, 602 had documented DUD. Unadjusted prevalence of DUD was 14.7% for Black, 7.6% for Hispanic, 6.4% for White, 4.2% for Other. Model 1 showed DUD prevalence [Black: 14.4% (95% CI 12.1-16.8), Hispanic: 7.6% (95% CI 4.8-10.3), White: 6.4% (95% CI 5.8-7.0), and Other: 4.0% (95% CI 1.9-6.2.)] Model 2 [Black: 11.5% (95% CI 9.6-13.4), Hispanic: 7.4% (95% CI 4.8-10.0), White: 6.7% (95% CI 6.1-7.3), and Other: 4.0% (95% CI 1.9-6.0.)] Model 3 [Black: 11.3% (95% CI 9.5-13.1), Hispanic: 8.1% (95% CI 5.4-10.8), White: 6.7% (95% CI 6.1-7.3), and Other: 4.2% (95% CI 2.1-6.4.)] Model 4 [Black: 10.3% (95% CI 8.6-12.0), Hispanic: 7.7% (95% CI 5.1-10.2), White: 6.8% (95% CI 6.2-7.4), and Other: 4.3% (95% CI 2.2-6.4.)] Conclusions: Among transgender veterans, prevalence of DUD was highest for Black and Hispanic patients. Group differences were attenuated after adjusting for potential sequelae of SDR. Addressing upstream SDR, alongside clinical interventions, may address high prevalence of DUD in patients with intersecting minoritized identities.

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