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Housing Instability Characteristics Among Transgender Veterans Cared for in the Veterans Health Administration,
Sarah P Carter1, Ann E Montgomery1, Emmett R Henderson1
1Sarah P. Carter is with the Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Services, Seattle, WA. Ann E. Montgomery is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Philadelphia, PA. Emmett R. Henderson is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Bryan Ketterer and John R. Blosnich are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh. Melissa Dichter is with the Center for Health Equity Research and Promotion, Department of Veterans Affairs, Crescenz Veterans Affairs Medical Center, Philadelphia. Adam J. Gordon is with the Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City. Jillian C. Shipherd and Michael R. Kauth are with the LGBT Health Program, Department of Veterans Affairs, Washington, DC.
Abstract:
Objectives. To characterize housing instability among transgender veterans using Veterans Health Administration (VHA) health care in the United States.Methods. We used administrative data on veterans screened for housing instability from 2013 to 2016; participants included 5717 transgender veterans and 17 133 cisgender veterans. We defined housing instability by a positive screen or VHA Homeless Program use. We identified gender from medical records, reflecting either birth sex or gender identity. We identified transgender identity through transgender-related International Classification of Diseases, Ninth Revision and Tenth Revision codes. A multiple logistic regression assessed the association of transgender identity with housing instability.Results. Prevalence of housing instability was nearly 3 times higher among transgender veterans than among cisgender veterans (19.9% vs 6.7%; P < .001). The difference persisted when we adjusted for sociodemographics (adjusted odds ratio = 2.32; 95% confidence interval = 2.09, 2.57). Transgender veterans experiencing housing instability were more likely than cisgender veterans to be women, younger, unmarried, and White.Conclusions. Transgender veterans experience housing instability more frequently than do cisgender veterans. An increased focus on transgender identity is critical for reducing veteran homelessness.
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