Transformative Health Systems Research to Improve Veteran Equity and Independence Center of Innovation, Veterans Affairs Providence Healthcare System, Providence, Rhode Island.
LGBTQ+ Health Program, Veterans Health Administration, Department of Veterans Affairs, Washington, DC.
JAMA Netw Open. 2024 Nov 4;7(11):e2442979. doi: 10.1001/jamanetworkopen.2024.42979.
Food insecurity is associated with numerous adverse health outcomes. Little is known about the prevalence of and risks for food insecurity among veterans identifying as lesbian, gay, bisexual, queer, and similar (LGBQ+), a population facing unique social barriers and medical comorbidities.
To examine food insecurity and potential risk factors among LGBQ+ veterans.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, cross-sectional study used administrative data from all US Veterans Health Administration (VHA) facilities nationally. Participants included veterans screened for food insecurity between March 1, 2021, and August 31, 2023.
Positive response to food insecurity screening administered in VHA facilities as part of routine clinical care.
Prevalence of and sociodemographic, clinical, and psychosocial factors associated with food insecurity among veterans identifying as LGBQ+ or heterosexual and those with "don't know" responses regarding their sexual orientation.
Of 3 580 148 veterans screened, the mean (SD) age was 61.6 (0.4) years; 3 192 507 (89.2%) were assigned male sex at birth. A total of 83 292 veterans (2.3%) identified as LGBQ+, and 10 183 (0.3%) had "don't know" responses. LGBQ+ veterans (5352 [6.4%]) and veterans with "don't know" responses (635 [6.2%]) were more than twice as likely as heterosexual veterans (90 426 [2.6%]) to have positive screen results for food insecurity. While risk factors for food insecurity were similar for veterans across sexual orientation groups, LGBQ+ veterans had higher rates of several risk factors compared with heterosexual veterans, including age younger than 45 years (45.3% vs 19.5%), female sex assigned at birth (44.1% vs 10.0%), being in a minoritized racial or ethnic group (34.7% vs 29.8%), unmarried or unpartnered status (69.1% vs 39.7%), low income (16.4% vs 14.9%), homelessness or housing instability (10.3% vs 5.4%), anxiety (7.7% vs 4.3%), depression (31.1% vs 19.3%), suicidality (3.6% vs 1.4%), posttraumatic stress disorder (42.2% vs 30.2%), substance use disorder (13.1% vs 9.0%), military sexual trauma (24.0% vs 5.4%), and recent intimate partner violence (2.6% vs 1.4%).
In this cohort study of veterans screened for food insecurity, LGBQ+ veterans and those with "don't know" responses for sexual orientation experienced food insecurity at nearly 2.5 times the rate of heterosexual veterans. While risk factors for food insecurity were similar across groups, LGBQ+ veterans faced a higher prevalence of particular risks, including homelessness and several mental health and trauma-related comorbidities. Future work should examine targeted screening and interventions tailored to identifying and addressing food insecurity in this population, given their increased vulnerability and burden of food insecurity.
粮食不安全与许多不良健康结果有关。在自认为是女同性恋、男同性恋、双性恋、酷儿和类似群体（LGBQ+）的退伍军人中，粮食不安全的流行程度和风险知之甚少，这一人群面临着独特的社会障碍和医疗合并症。
检查 LGBQ+退伍军人中的粮食不安全和潜在风险因素。
设计、地点和参与者：这是一项回顾性、横断面研究，使用了全国所有美国退伍军人健康管理局（VHA）设施的行政数据。参与者包括在 2021 年 3 月 1 日至 2023 年 8 月 31 日期间接受粮食不安全筛查的退伍军人。
在 VHA 设施中作为常规临床护理的一部分进行粮食不安全筛查的阳性反应。
在自认为是 LGBQ+或异性恋的退伍军人中，以及对自己的性取向有“不知道”反应的退伍军人中，粮食不安全的流行程度以及与粮食不安全相关的社会人口学、临床和心理社会因素。
在接受筛查的 3580148 名退伍军人中，平均（SD）年龄为 61.6（0.4）岁；3192507 名（89.2%）出生时被分配为男性。共有 83292 名退伍军人（6.4%）自认为是 LGBQ+，10183 名（0.3%）有“不知道”的反应。LGBQ+退伍军人（5352[6.4%]）和有“不知道”反应的退伍军人（635[6.2%]）与异性恋退伍军人（90426[2.6%]）相比，粮食不安全筛查结果呈阳性的可能性高出两倍以上。虽然粮食不安全的风险因素在不同性取向群体的退伍军人中相似，但 LGBQ+退伍军人与异性恋退伍军人相比，有更高的几种风险因素的发生率，包括年龄小于 45 岁（45.3%比 19.5%）、出生时被分配为女性（44.1%比 10.0%）、属于少数族裔或少数民族（34.7%比 29.8%）、未婚或未婚（69.1%比 39.7%）、低收入（16.4%比 14.9%）、无家可归或住房不稳定（10.3%比 5.4%）、焦虑（7.7%比 4.3%）、抑郁（31.1%比 19.3%）、自杀意念（3.6%比 1.4%）、创伤后应激障碍（42.2%比 30.2%）、物质使用障碍（13.1%比 9.0%）、军事性创伤（24.0%比 5.4%）和最近的亲密伴侣暴力（2.6%比 1.4%）。
在这项对接受粮食不安全筛查的退伍军人的队列研究中，LGBQ+退伍军人和对性取向有“不知道”反应的退伍军人经历粮食不安全的比例几乎是异性恋退伍军人的 2.5 倍。虽然粮食不安全的风险因素在各组之间相似，但 LGBQ+退伍军人面临更高的特定风险发生率，包括无家可归和几种心理健康和创伤相关的合并症。鉴于这一人群的脆弱性和粮食不安全负担增加，未来的工作应研究针对这一人群的有针对性的筛查和干预措施，以确定和解决粮食不安全问题。
