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Exploring Rural Disparities in Medical Diagnoses Among Veterans With Transgender-related Diagnoses Utilizing Veterans
Leigh A Bukowski1, John Blosnich, Jillian C Shipherd
1*Department of Behavioral and Community Health Sciences †Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh ‡US Department of Veterans Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA §Lesbian Gay Bisexual Transgender (LGBT) Program, Office of Patient Care Services, Veterans Health Administration, Washington, DC ∥National Center for PTSD, Women's Health Sciences Division ¶VA Boston Healthcare System #Boston University School of Medicine, Boston, MA **VA South Central Mental Illness Research, Education, and Clinical Center ††Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety ‡‡Baylor College of Medicine, Houston, TX §§Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City ∥∥Mountain Home VA Medical Center, Mountain Home, TN ¶¶Division of General Internal Medicine, School of Medicine, University of Pittsburgh, UPMC Montefiore Hospital, Pittsburgh, PA.
Objectives:
Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses.
Methods:
This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions.
Results:
Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest.
Conclusions:
This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research.
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