Associations between violence, distress, and cancer in transgender and non-transgender people.

Abstract

10566 Background: Due to transphobia, transgender people experience extreme rates of violence and distress. In other populations, violence and distress have been linked to increased cancer morbidity and mortality likely due to increased inflammation and higher rates of cancer risk factors. Methods: To evaluate associations between gender identity, violence, distress, cancer risk factors, and cancer, we developed an a priori structural equations model (SEM) and conducted a cross-sectional cohort study using electronic medical record data entered between 2006-2021 at a New York academic hospital. Participants were adults identified as transgender (N=894) by diagnosis codes, keyword searches, and structured gender identity information. We used age and follow-up time to match this cohort with participants not identified as transgender (N=1788) (2:1). We noted experiences of violence using keyword searches, diagnosis codes, and a screening question, “Are you safe at home?” We assessed distress as a latent factor based on mental illness diagnosis codes and keyword searches and diagnosis codes related to childhood violence. Cancer risk factors included ever smoking, body mass index ≥ 30, and history of HIV, HPV, or hepatitis B or C. We made unadjusted comparisons of violence, distress, cancer risk factors, and cancer in transgender and non-transgender people using two-sample chi-square tests. Our SEM included a direct path from gender identity to cancer or precancerous lesions as well as indirect paths through intermediaries of adult violence, distress, and cancer risk factors. We assessed direct paths for statistical significance using z-tests and indirect paths using bias-corrected bootstrap confidence intervals. Results: The association between gender identity and probability of cancer transmitted through the intermediate variables of violence, distress, and having multiple cancer risk factors was significant (p=0.05). Conclusions: In our model, transgender people experienced high rates of violence and distress, both of which were associated with cancer risk factors and cancer. Transphobia and violence experienced by transgender people must be addressed and mitigated. More work is needed to better understand associations between violence, distress, and cancer risk. [Table: see text]