, Volume 1, Issue 4, pp 257-266
Date: 16 Jul 2014

Racial Health Disparities in a Cohort of 5,135 Transgender Veterans



There are no large-scale studies of racial health disparities in transgender patients. The Veterans Health Administration (VHA) is the largest health-care system in the United States and was an early adopter of electronic health records. We present new data on medical and mental health disparities in a large population of transgender veterans.


Using four ICD-9-CM codes, we identified a cohort of transgender veterans who presented for VHA care from1996–2013. A total of 5,135 transgender veterans were identified, 387 were non-Hispanic Black and 4,120 were non-Hispanic White. These two groups were compared to determine if medical and/or mental health disparities existed.


Black transgender veterans had increased odds to be diagnosed with alcohol abuse (adjusted odds ratio [AOR] = 1.86, 95 % confidence interval [CI] = 1.50–2.31, p < 0.0001), benign prostatic hyperplasia (AOR = 1.36, CI = 1.01–1.84, p < 0.05), congestive heart failure (AOR = 1.51, CI = 1.04–2.19, p < 0.05), HIV/AIDS (AOR = 6.77, CI = 4.60–9.97, p < 0.0001), hypertension (AOR = 1.71, CI = 1.34–2.17, p < 0.0001), end-stage renal disease (AOR = 3.34, CI = 1.65–6.93, p < 0.001), serious mental illness (AOR = 1.35, CI = 1.09–1.68, p < 0.01), and tobacco use (AOR = 1.29, CI = 1.04–1.59, p < 0.05). However, the odds of Black transgender veterans to be diagnosed with the following conditions were reduced: depression (AOR = 0.73, CI = 0.58–0.93, p < 0.01), hypercholesterolemia (AOR = 0.71, CI = 0.57–0.89, p < 0.01), and obesity (AOR = 0.79, CI = 0.63–0.98, p < 0.05). Black transgender veterans’ odds of having a history of incarceration was nearly three times larger (AOR = 2.91, CI = 1.84–4.62, p < 0.0001) and their odds of experiencing homelessness was nearly two times larger (AOR = 1.85, CI = 1.49–2.31, p < 0.0001) than White transgender veterans. The odds of Black transgender veterans to live in a rural area was 65 % less than that of White transgender veterans (AOR = 0.35, CI = 0.27–0.46, p < 0.0001).


This is the first study to examine a large cohort of transgender patients for the presence of racial disparities in psychiatric and medical health outcome disparities using retrospective medical chart data. Black transgender veterans were found to have a greater likelihood of social disadvantage and prevalence of several mental and medical conditions compared to White transgender veterans. Racial disparities occurred in a context of global health disparities in transgender veterans, as a group, compared to non-transgender veterans. These findings may have implications for policy, prevention strategies, and health-care delivery in VA and other health-care systems.

Disclaimer: The views expressed in this manuscript are those of the authors and do not necessarily reflect those of the United States Government or any of its departments or agencies, or the views of the affiliated academic institution (East Tennessee State University).