Garcia Gutiérrez Jessie M, Reed David E, Macia Kathryn S, Fletcher Olivia, Williams Emily C, Chen Jessica A
Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA.
Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA; Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
Soc Sci Med. 2025 Jul 5;382:118369. doi: 10.1016/j.socscimed.2025.118369.
Due to marginalization, transgender and people of color living in the United States (U.S.) experience disparities in social determinants of health and mental health outcomes. Evidence suggests that applying an intersectional analysis among U.S. transgender Veterans of color would reveal disparities in social stressors and alcohol use outcomes.
This project sought to examine patterns of social stressors and alcohol use among ethnoracial groups of transgender Veterans receiving care in the Veterans Health Administration (VA).
Data from electronic health records of transgender Veterans receiving VA care from October 1, 2009 to July 31, 2017 were used to estimate prevalence of social stressors and patterns of unhealthy alcohol use for 6 ethnoracial groups. Additionally, we tested whether the number of social stressors mediated differences in diagnosed alcohol use disorder (AUD) among Black versus White transgender Veterans.
Transgender Veterans of color had higher prevalence of social stressors and unhealthy alcohol use as compared to White transgender Veterans. For instance, 14.5 % of Black transgender Veterans had diagnosed AUD compared to 7.8 % of White transgender Veterans. Black transgender Veterans' greater exposure to social stressors partially explained their higher rates of AUD when compared with White transgender Veterans.
Our findings highlight the impact of social stressors on unhealthy alcohol use among transgender Veterans of color. They also suggest the need to monitor and address social stressors given the changing political environment in the U.S.
由于边缘化问题，生活在美国的跨性别者和有色人种在健康和心理健康结果的社会决定因素方面存在差异。有证据表明，对美国有色人种跨性别退伍军人进行交叉性分析将揭示社会压力源和酒精使用结果方面的差异。
本项目旨在研究在退伍军人健康管理局（VA）接受护理的不同种族跨性别退伍军人群体中的社会压力源模式和酒精使用情况。
使用2009年10月1日至2017年7月31日期间接受VA护理的跨性别退伍军人电子健康记录中的数据，来估计6个种族群体的社会压力源患病率和不健康酒精使用模式。此外，我们还测试了社会压力源的数量是否介导了黑人和白人跨性别退伍军人在诊断酒精使用障碍（AUD）方面的差异。
与白人跨性别退伍军人相比，有色人种跨性别退伍军人的社会压力源患病率和不健康酒精使用率更高。例如，14.5%的黑人跨性别退伍军人被诊断患有AUD，而白人跨性别退伍军人的这一比例为7.8%。与白人跨性别退伍军人相比，黑人跨性别退伍军人更多地暴露于社会压力源中，这在一定程度上解释了他们较高的AUD发生率。
我们的研究结果凸显了社会压力源对有色人种跨性别退伍军人不健康酒精使用的影响。鉴于美国不断变化的政治环境，这些结果还表明需要监测和应对社会压力源。
