Primary Care-Based Alcohol Screening and Alcohol Use Among Transgender and Cisgender Adults in an Integrated Health...

Alcohol screenings and excessive alcohol use among transgender adults remain understudied. Prior research is limited by small samples, poor generalizability, and lack of validated gender identity data. This study examined alcohol screening rates and excessive use among transgender and cisgender adult members of a large, integrated health system.

Electronic health record data from Kaiser Permanente Northern California (2013-2021) were analyzed. Gender identity was previously verified. Primary outcomes included completion of a standardized alcohol screening over a 2-year follow-up and alcohol use exceeding national sex- and age-based limits. Concordance between screening parameters and sex assigned at birth versus gender identity was explored.

Of the 7,933 transgender and 128,577 cisgender adults studied, 76% and 66% received alcohol screening, respectively. Transgender individuals had higher alcohol screening rates (adjusted hazard ratio=1.08; 95% CI=1.05, 1.11), and 68.3% were screened using drinking limits based on sex assigned at birth. Among those screened, excessive alcohol use was lower among transgender individuals (8.2% vs 10.6%; adjusted prevalence ratio=0.85; 95% CI=0.78, 0.93). Prevalence of excessive alcohol use was similar regardless of whether screening parameters aligned with sex assigned at birth or gender identity.

Transgender individuals were more likely to receive alcohol screening, and those screened had lower prevalence of excessive alcohol use than cisgender comparators. This study adds to the limited literature on how transgender populations are screened in a real-world clinical setting and may inform future alcohol screening practices and guideline development.