Department of Internal Medicine, Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA.
Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA.
LGBT Health. 2021 Feb-Mar;8(2):143-151. doi: 10.1089/lgbt.2020.0152. Epub 2021 Jan 28.
Transgender veterans are overrepresented in the Veterans Health Administration (VHA) compared with in the general population. Utilization of multiple different health care systems, or health care mobility, can affect care coordination and potentially affect outcomes, either positively or negatively. This study examines whether transgender veterans are more or less health care mobile than nontransgender veterans and compares the patterns of geographic mobility in these groups. Using an established cohort ( = 5,414,109), we identified 2890 transgender veterans from VHA electronic health records from 2000 to 2012. We compared transgender and nontransgender veterans on sociodemographic, clinical, and health care system-level measures and conducted conditional logistic regression models of mobility. Transgender veterans were more likely to be younger, White, homeless, have depressive disorders, post-traumatic stress disorder (PTSD), and hepatitis C. Transgender veterans were more likely to have been health care mobile (9.9%) than nontransgender veterans (5.2%) (unadjusted odds ratio = 2.02, 95% confidence interval = 1.73-2.36). In a multivariable model, transgender status, being separated/divorced, receiving care in less-complex facilities, and diagnoses of depression, PTSD, or hepatitis C were associated with more mobility, whereas older age was associated with less mobility. For the top three health care systems utilized, a larger proportion of transgender veterans visited a second health care system in a different state (56.2%) than nontransgender veterans (37.5%). Transgender veterans were more likely to be health care mobile and more likely to travel out of state for health care services. They were also more likely to have complex chronic health conditions that require multidisciplinary care.
跨性别退伍军人在退伍军人健康管理局（VHA）中的比例高于普通人群。使用多种不同的医疗保健系统，或医疗保健流动，可能会影响护理协调，并可能对结果产生积极或消极的影响。本研究检查了跨性别退伍军人是否比非跨性别退伍军人更频繁地流动，以及比较了这两个群体的地理流动模式。使用一个已建立的队列（ = 5414109），我们从 2000 年至 2012 年从退伍军人健康管理局的电子健康记录中确定了 2890 名跨性别退伍军人。我们比较了跨性别和非跨性别退伍军人在社会人口统计学、临床和医疗保健系统水平的措施，并对流动性进行了条件逻辑回归模型。跨性别退伍军人更年轻、更白、无家可归、患有抑郁障碍、创伤后应激障碍（PTSD）和丙型肝炎的可能性更大。与非跨性别退伍军人（5.2%）相比，跨性别退伍军人更有可能（9.9%）进行医疗保健流动（未经调整的优势比 = 2.02，95%置信区间 = 1.73-2.36）。在多变量模型中，跨性别身份、离异、在较不复杂的医疗机构接受治疗以及抑郁、PTSD 或丙型肝炎的诊断与更高的流动性相关，而年龄较大与较低的流动性相关。在使用的前三大医疗保健系统中，更多的跨性别退伍军人（56.2%）到另一个州的第二家医疗保健系统就诊，而非跨性别退伍军人（37.5%）。跨性别退伍军人更有可能进行医疗保健流动，更有可能到州外寻求医疗服务。他们也更有可能患有需要多学科治疗的复杂慢性健康状况。
