Abstract
Substance use disorders are a major source of morbidity and mortality in the United States. National data comparing the prevalence of substance use disorder diagnoses (SUDDs) among transgender and cisgender individuals are lacking in the United States. To investigate the prevalence of SUDDs among transgender and cisgender adults and to identify within-group and between-group differences by age, gender, and geographic location. This cross-sectional study used the OptumLabs Data Warehouse to analyze deidentified claims from approximately 74 million adults aged 18 years or older enrolled in commercial or Medicare Advantage insurance plans in 2017. A total of 15 637 transgender adults were identified based on a previously developed algorithm using a combination of International Classification of Diseases, Tenth Revision (ICD-10) transgender-related diagnosis and procedure codes and sex-discordant hormone prescriptions. A cohort of 46 911 cisgender adults was matched to the transgender cohort in a 3:1 ratio based on age and geographic location. SUDDs, based on ICD-10 codes, were assessed overall and compared between transgender and cisgender cohorts and by geographic region (ie, Northeast, Midwest, South, and West); age groups (eg, 18-25, 26-30, 31-35 years), and gender (ie, transfeminine [TF; assigned male sex at birth, identify along feminine gender spectrum], transmasculine [TM; assigned female sex at birth, identify along masculine gender spectrum], male, and female). In this study of 15 637 transgender adults (4955 [31.7%] TM) and 46 911 cisgender adults (23 247 [50.4%] men), most (8627 transgender adults [55.2%]; 51 762 cisgender adults [55.2%]) were aged between 18 and 40 years, and 6482 transgender adults (41.5%) and 19 446 cisgender adults (41.5%) lived in the South. Comparing transgender to cisgender groups, significant differences were found in the prevalence of a nicotine (2594 [16.6%] vs 2551 [5.4%]; P < .001), alcohol (401 [2.6%] vs 438 [0.9%]; P < .001), and drug (678 [4.3%] vs 549 [1.2%]; P < .001) SUDDs. Among transgender adults, cannabis was the most prevalent drug SUDD (321 [2.1%]), followed by opioid SUDD (205 [1.3%]) and cocaine SUDD (81 [0.5%]), whereas among cisgender adults, cannabis and opioid SUDDs were equally prevalent (cannabis, 186 [0.4%]; opioid, 207 [0.4%]), followed by cocaine SUDD (59 [0.1%]). In this study, the prevalence of SUDDs was significantly elevated among transgender adults relative to their cisgender peers. These findings underscore the need for culturally tailored clinical interventions to treat substance use disorder in transgender populations.
Highlights
Comparing transgender to cisgender groups, significant differences were found in the prevalence of a nicotine (2594 [16.6%] vs 2551 [5.4%]; P < .001), alcohol (401 [2.6%] vs 438 [0.9%]; P < .001), and drug (678 [4.3%] vs 549 [1.2%]; P < .001) substance use disorder diagnoses (SUDDs)
When comparing the prevalence of SUDDs among transgender people, those in the Northeast had a significantly higher prevalence of nicotine (352 [17.9%]), alcohol (65 [3.3%]), cannabis (62 [3.2%]), cocaine (19 [1.0%]), opioid (32 [1.6%]), and another (49 [2.5%]) SUDD compared with transgender people in other regions
When examining differences according to age, our study found that transgender adults aged 18 to 25 years had the highest burden of all SUDDs relative to older transgender people and cisgender people of all ages
Summary
Transgender people, whose gender identity differs from their assigned birth sex and who may access hormones or surgery to align their physical gender expression with their gender identity, are at risk of substance abuse and dependence.[1,2,3,4,5,6,7,8] Research suggests that substance misuse and related disorders are in part associated with some transgender people’s reliance on substances to cope with the psychological toll of discrimination.[9,10,11] While research has captured the burden of substance misuse among transgender people,[1,2,3,4,5,6,7] estimates of substance use disorder (SUD) are limited and vary considerably (ie, 3.9% to 47.2%) depending on the sample and SUD type.[3,5,12,13,14,15,16,17,18]Much of the research documenting the burden of substance use and related disorders among transgender individuals has relied on geographically limited, survey-based research that often focuses on high-risk subgroups, including younger transgender people and transfeminine (TF) people.[2,3,4,19,20,21] In addition to the frequent reliance on self-reported outcomes, survey-based research only collects data from individuals who self-identify as transgender and elect to participate in research, which raises concerns about the generalizability of findings. Despite the benefits of using administrative claims databases to study substance use disorder diagnoses (SUDDs) among transgender people, few studies use this approach. Those that do typically focus on narrow populations (eg, transgender veterans),[17,18] fail to report the full range of SUDDs (eg, nicotine, alcohol, cannabis, opioid, cocaine),[12,13,16,17,18] or fail to examine differences by gendered subgroups (eg, TF vs transmasculine [TM] people)[12,13,17,18] or across geographic regions.[12,13,16,17,18]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
