Errors in Abstract, Methods, Results, Figure, and Tables

In the Original Investigation titled “Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults,”¹ published February 4, 2021, there were errors in the Abstract, Methods, Results, the Figure, Table 1, and Table 2. In the Abstract, Results, and Table 1, the number of male cisgender adults should have read 23 247 and the number of cisgender female adults should have read 23 664. In the Methods, Table 1, and the Figure, the age ranges should have read 41 to 45 years and 46 to 50 years. In the results, the P values for the comparison of cannabis and cocaine substance use disorder diagnoses were incorrect. The P value for cannabis should have been .001; for cocaine, .13. The title of Table 2 should have indicated that there were 49 611 cisgender adults in the sample. This article has been corrected.¹

Key Points

Question What is the prevalence of substance use disorder diagnoses (SUDDs) among US transgender and cisgender adults?

Findings In this study of 15 637 transgender and 46 911 cisgender adults, transgender adults had a significantly higher prevalence of nicotine, alcohol, and drug SUDDs than cisgender adults.

Meaning In this study, transgender adults experienced elevated levels of SUDD relative to their cisgender peers, suggesting that effective, culturally tailored SUDD treatment interventions are warranted.

Introduction

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.^1-8 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.^9-11 While research has captured the burden of substance misuse among transgender people,^1-7 estimates of substance use disorder (SUD) are limited and vary considerably (ie, 3.9% to 47.2%) depending on the sample and SUD type.^3,5,12-18

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.^2-4,19-21 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. Conversely, health care administrative databases enable the identification of large, geographically representative cohorts of transgender individuals and allow for comparisons to be made between cisgender (ie, nontransgender) and transgender people. Despite the benefits of using administrative claims databases to study substance use disorder diagnoses (SUDDs) among transgender people, few studies use this approach. Furthermore, 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),^12,13,16-18 or fail to examine differences by gendered subgroups (eg, TF vs transmasculine [TM] people)^12,13,17,18 or across geographic regions.^12,13,16-18

The present study aimed to fill these gaps by using a large, national administrative claims database to identify the distribution of SUDDs among transgender and cisgender adults across key subgroups defined by age, gender, and geographic region. The analyses were driven by the overarching goal of identifying subpopulations at greatest risk of SUDDs so that culturally tailored clinical interventions can be developed to treat SUDDs among the most at-risk segments of the transgender population.

Methods

We conducted a cross-sectional analysis of the OptumLabs Data Warehouse (OLDW), which includes deidentified claims data for commercially insured and Medicare Advantage enrollees. The patient-level information in the OLDW comprises enrollment, medical claims, and pharmacy claims across care settings. Our study sample was drawn from approximately 74 million adults (ie, ≥18 years of age) enrolled in commercial or Medicare Advantage plans in 2017. The study was approved by the institutional review boards of Boston University and the RAND Corporation. Given that this is a secondary data analysis of a deidentified insurance claims dataset, collection of written informed consent was neither possible nor required. This study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

Cohort Identification and Stratification

To minimize missing data, only individuals who were enrolled for all of 2017 and had at least 5 medical claims reported in 2017 were included in this analysis. Using our previously developed algorithm,²² we identified a cohort of transgender adults using a combination of International Classification of Diseases, Ninth (ICD-9) and ICD-10 diagnostic codes specific to transgender individuals; Common Procedural Terminology codes for transgender-related surgical procedures; and the use of sex-discordant hormones. A cisgender cohort was matched 3:1 to the transgender cohort based on birth year and geographic region (ie, Northeast, South, Midwest, West).

Measures

Outcomes

SUDDs were identified using ICD-10 codes from health care encounter claims in 2017 and included alcohol, nicotine, cannabis, cocaine, and opioids (see eAppendix in the Supplement). The ICD-10 also includes codes for other psychoactive substance-related diagnoses. Due to the low prevalence of sedative, stimulant, and hallucinogen SUDDs, individuals with diagnosis codes related to these disorders were included in the other SUDD group. To compare findings with the US general population,²³ nonalcohol and nonnicotine SUDDs were combined to create an indicator of drug SUDDs. The polysubstance SUDD variable included individuals with 2 or more SUDDs.

Demographic Characteristics

Age was divided into 9 categories, as follows: 18 to 25; 26 to 30; 31 to 35; 36 to 40; 41 to 45; 46 to 50; 51 to 55; 56 to 60; and 61 years or older. For cisgender people, gender was categorized as male vs female. For transgender people, gender was categorized as TF, TM, and unknown.²² TF individuals were defined as transgender people who received feminizing hormones and/or had received a feminizing surgical procedure (eg, vaginoplasty). TM individuals were defined as transgender people who received masculinizing hormones and/or had sentinel surgeries (eg, metoidioplasty or phalloplasty). The remaining transgender cohort, most of whom were classified as transgender based on a gender-related diagnostic code (eg, gender identity disorder), did not have claims for hormones or surgeries that allowed for their categorization as TF or TM.

Statistical Analysis

Analyses were performed using SAS version 9.4 (SAS Institute). Due to our cohort inclusion criteria (ie, full year of enrollment, minimum of 5 claims), there were no missing data. Period prevalence estimates for each SUDD were calculated for 2017 among transgender and cisgender individuals. We used 2-tailed χ² tests, with statistical significance set at P < .05, to assess within-group differences (among transgender people and among cisgender people) and between-group differences (across transgender and cisgender people) in SUDD by geographic region, age, and gender subgroup (TF vs TM; male vs female). Transgender individuals with an unknown gender were excluded from the within-group, gender-stratified analysis.

Results

In this US study of 15 637 transgender individuals (2079 [13.3%] TF; 4955 [31.7%] TM; 8603 [55.0%] unknown gender) and 46 911 cisgender individuals (23 664 [50.4%] female; 23 247 [49.6%] male), most (8627 transgender adults [55.2%]; 51 762 cisgender adults [55.2%]) were between 18 and 40 years of age, and the largest proportion lived in the South (6482 transgender adults [41.5%]; 19 446 cisgender adults [41.5%]) (Table 1). Significantly more transgender people than cisgender people had a nicotine (2594 [16.6%] vs 2551 [5.4%]; P < .001), alcohol (401 [2.6%] vs 438 [0.9%]; P < .001), or drug (678 [4.3%] vs 549 [1.2%]; P < .001) SUDD. Significantly more transgender individuals had a polysubstance SUDD than cisgender individuals (310 [2.0%] vs 245 [0.5%]; P < .001). Among transgender individuals, cannabis was the most prevalent drug SUDD (321 [2.1%]), followed by opioid (205 [1.3%]) and cocaine (81 [0.5%]) SUDDs. Among cisgender people, cannabis and opioid SUDDs were equally prevalent (cannabis, 186 [0.4%]; opioid, 207 [0.4%]), followed by cocaine SUDD (59 [0.1%]).

Table 1. Characteristics of a Cohort of 15 637 Transgender Adults and a Cohort of 46 911 Cisgender Adults in the US, 2017

When examining differences in SUDD by geographic region (Table 2), transgender people within each region had a significantly higher prevalence of all SUDDs relative to cisgender people, except for cocaine SUDD in the West. 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. A similar pattern was observed among cisgender people; with the exception of nicotine SUDD, which was highest among cisgender people in the Midwest (695 [6.2%]) followed by those in the South (1165 [6.0%]), Northeast (281 [4.8%]), and West (410 [4.0%]) (P < .001).

Table 2. Prevalence of SUDDs by Geographic Region Among 15 637 Transgender and 46 911 Cisgender Adults, 2017^a

The Figure presents differences in the prevalence of SUDDs between transgender and cisgender people across age groups. Transgender people in each age group had a significantly higher prevalence of polysubstance, alcohol, nicotine, and drug SUDD relative to cisgender people. For transgender and cisgender people, polysubstance (transgender, 134 of 4084 [3.3%]; cisgender, 122 of 12 252 [1.0%]), alcohol (transgender, 130 [3.2%]; cisgender, 156 [1.3%]), and drug (transgender, 269 [6.6%]; cisgender, 243 [2.0%]) SUDDs were highest among those aged 18 to 25 years. The inverse was observed with regard to nicotine SUDD, which was highest among those aged 61 years or older (transgender, 575 of 2130 [27.0%]; cisgender, 700 of 6390 [11.0%]).

Figure. Frequency of Substance Use Disorder Diagnoses (SUDDs) by Age Among US Transgender (n = 15 637) and Cisgender (n = 46 911) Adults, 2017

Table 3 presents stratified analyses between the cisgender sample and a subset (7034 [45.0%]) of the transgender sample for which gender spectrum (TF or TM) could be determined. Among the transgender subsample, TF people had a significantly higher prevalence of every SUDD relative to TM people, with TF individuals having approximately 3 times the prevalence of polysubstance (49 of 2079 [2.4%] vs 39 of 4955 [0.8%]; P < .001), cannabis (48 [2.3%] vs 42 [0.8%]; P < .001), and cocaine (18 [0.9%] vs <0.3%; P < .001) SUDDs, and 2.3 times the prevalence of alcohol SUDD (53 [2.5%] vs 56 [1.1%]; P < .001). Among cisgender people, male adults compared with female adults had approximately 2 times the prevalence of polysubstance (159 of 23 247 [0.7%] vs 87 of 23 664 [0.4%]; P < .001), alcohol (283 [1.2%] vs 155 [0.7%]; P < .001), and cannabis (115 [0.5%] vs 72 [0.3%]; P = .001) SUDDs. There was a higher prevalence of cocaine SUDD among male vs female cisgender adults, but the comparison was not statistically significant (35 [0.2%] vs 24 [0.1%]; P = .13).

Table 3. Substance Use Disorder Diagnoses by Gender Among Transfeminine Individuals, Transmasculine Individuals, Cisgender Male Individuals, and Cisgender Female Individuals in the US, 2017

Discussion

To our knowledge, this study represents the largest national study of SUDD disparities among transgender and cisgender adults to date. In 2017, the prevalence of polysubstance SUDD among transgender people in our sample was 4 times that of their cisgender peers. Moreover, the prevalence of any drug SUDD among transgender people was 3.6 times that of cisgender people in our sample and approximately 1.6 times that of the US general population in 2017.²³ Findings underscore the need for future research to examine the SUDD treatment experiences of transgender individuals so that effective clinical interventions can be developed to reduce the burden of SUDD among this population.

When examining SUDDs separately, significant disparities were observed. Notably, nicotine SUDD was the most prevalent SUDD for both transgender and cisgender individuals, although the prevalence was significantly higher among transgender people (16.6%) than cisgender individuals (5.4%) in the sample. While national data comparing the prevalence of diagnosed nicotine disorder among transgender and cisgender people are lacking, prior research among lesbian, gay, bisexual, and transgender (LGBT) populations has documented elevated rates of nicotine use and the need for interventions to mitigate the harms of nicotine consumption among these populations, particularly cigarette smoking.^24-27 Regarding cannabis, transgender individuals in this sample had more than 5 times the prevalence of cannabis SUDD than cisgender people and 1.5 times that of the 2017 US general population.²³ Similarly, transgender individuals in this sample had 4 times the prevalence of cocaine SUDD and 3 times the prevalence of opioid SUDD relative to cisgender people and 1.4 and 1.7 times the prevalence of cocaine and opioid SUDD, respectively, relative to the 2017 US general population.²³ Research has found that transgender individuals frequently use substances to cope with discrimination.^9-11 While the use of substances such as nicotine, cannabis, cocaine, and opioids may be an effective short-term strategy to cope with the stress of discrimination, these substances carry a myriad of health risks.^28-30 Transgender individuals who use substances to cope with discrimination may benefit from engagement in clinical interventions that promote positive coping strategies such as meditation, exercise, or peer support.^10,31

Much of the prior substance use research with transgender people is geographically limited, and the national research that does exist routinely fails to explore regional differences in SUDD. In this study, we found that transgender individuals in the Northeast, South, Midwest, and West consistently had higher rates of nicotine, alcohol, and all other SUDDs relative to cisgender individuals within the same region. We also found that transgender people in the Northeast had significantly higher prevalence of nicotine, alcohol, cannabis, cocaine, opioid, and other SUDDs relative to transgender individuals in other regions. The prevalence of alcohol and cocaine SUDD was similarly elevated among cisgender individuals in the Northeast, relative to those in other regions. National 2017 data on US residents aged 12 years and older found that those living in the West had the highest prevalence of past-year drug misuse relative to those in other regions; however, the prevalence of substance use treatment was highest in the Northeast, relative to other regions.³² Since health care engagement is required to receive an SUDD, it may be that cisgender and transgender people from the West misuse drugs more, but those in the Northeast have greater access and/or motivation to engage in treatment. Differences in the regional distribution of SUDDs in our study relative to the distribution of SUDDs among the US general population, aged 12 years and older, may be due to the fact that our study included people with insurance aged 18 years and older and older age and insurance may be particularly protective against having an SUDD for those living in the West vs other US regions. Additional research is needed to understand the mechanisms driving geographic disparities in SUDD among cisgender and transgender people in the United States.

When examining differences according to age, our study found that transgender adults aged 18 to 25 years had the highest burden of all SUDDs (except nicotine) relative to older transgender people and cisgender people of all ages. Our study extends findings from much smaller observational studies documenting the high prevalence of disordered alcohol and drug use behaviors among younger transgender people^2,3,5,20,33 and also aligns with 2017 survey data showing an elevated prevalence of alcohol and drug SUDDs among young adults (aged 18-25 years) relative to older members of the US general population.²³ Notably, however, the prevalence of nicotine SUDD in the present study doubled among transgender individuals between the ages of 18 and 25 years and those aged 61 years and older and more than tripled among cisgender individuals across age groups. Although US general population data suggest greater nicotine use and dependence among younger adults,^34,35 concerns about the health risks of smoking and the desire to quit have been shown to increase with age,³⁶ and a significantly higher proportion of adults aged 65 years and older report being former smokers than those younger than 65 years.^35,37 Thus, the age-related disparities in nicotine SUDD documented among transgender and cisgender adults in our sample may reflect a greater recognition of problematic use and elevated treatment-seeking among adults in the older age groups relative to those in the younger age groups. Taken together, these findings highlight the need to detect and treat nicotine SUDD among US adults as they age and underscore the need for early prevention efforts to alleviate the burden of alcohol, cocaine, opioid, and other SUDDs among young adults, particularly those who are transgender.

Extending prior substance use research,^4,21 our gender-stratified subanalysis of the 7034 transgender people who had received gender-affirming hormones or surgery found that TF individuals had a higher prevalence of nearly every SUDD relative to TM individuals. Survey research has consistently documented the high prevalence of substance use and SUD among TF individuals alone^3,20,38 and relative to TM people^4,21,39; however, no national study, to our knowledge, has documented disparities in diagnosed SUD among TF and TM adults until now. The higher prevalence of SUDDs among TF people relative to TM individuals in our study could be attributed to the possibility that TF people experience greater stressors, have fewer adaptive stress management strategies, or clinically present with SUD symptoms at higher rates than TM people.^4,40 Additionally, consistent with prior research,^16,32,41 cisgender male adults in our sample also had a higher prevalence of alcohol and drug SUDDs than cisgender female adults; thus, there may be sex-related and developmental factors that lead individuals assigned a male birth sex to engage in heavier substance use and be diagnosed with an SUD more readily than individuals assigned a female birth sex.⁴¹ Future research is needed to explore the potential factors associated with the differential prevalence of SUDDs across gender subgroups.

Our research underscores the necessity of ensuring access to SUD treatment for transgender people. Findings also support the necessity of tailoring clinical interventions to the highest risk groups including TF people and young adults. Given early research suggesting that many substance use treatment facilities may be ill-equipped to meet the treatment needs of transgender adults with SUDDs^42,43 and the paucity of evidence-based SUD interventions for this population,⁴⁴ research that examines the treatment experiences and unmet treatment needs of transgender individuals with SUDDs is needed to inform future interventions for this population.

Limitations

Our analysis has several limitations. We used our previously developed algorithm²² that relied on diagnosis and procedure codes to identify transgender individuals with commercial or Medicare Advantage insurance. Moreover, only diagnosed SUDs were assessed. Given that lack of insurance is a barrier to accessing care and receiving an SUDD⁴⁵ and transgender individuals are more likely than the US general population to be uninsured⁶ and face numerous stigma-related barriers to health care engagement,^6,10 the SUDDs documented here are likely underestimates of the true burden of SUDD in the US transgender population. Additionally, the OLDW does not include self-reported beneficiary-level data on race; therefore, we were unable to explore racial differences in SUDDs. Given that greater substance use had been documented among transgender people of color than white transgender people,^3,46 future population-level research should aim to explore within-group SUDD disparities by race.

Additionally, our algorithm²² could only identify transgender individuals with a transgender-related diagnosis or gender-affirming hormones or surgery. Furthermore, our necessary reliance on feminizing and masculinizing hormones and procedures to categorize transgender individuals as TF and TM meant that the gender of 55% of the transgender cohort could not be categorized and these individuals were subsequently excluded from the gender-stratified subanalysis. Thus, the gender-stratified, transgender subanalysis is only representative of transgender individuals who have accessed gender-affirming hormones or surgery. Notably, across community-based studies, nonbinary individuals have comprised 35% to 42% of transgender samples^6,47,48 and many nonbinary individuals do not use gender-affirming hormones or procedures^6,49,50; thus, it is likely that most individuals who were excluded from our gender-stratified analyses were nonbinary people who had not accessed hormones or surgery. Furthermore, research finds that TF people are less likely to receive various forms of gender-affirming services than TM people^16,51 and nonreceipt of gender-affirming care is associated with substance use.^4,52 Thus, it is likely that the burden of SUDD would have been higher among both the TF and TM subsamples if individuals who had not accessed gender-affirming care had been included, with potentially wider SUDD disparities observed between the TF and TM subsamples. National data are needed to characterize SUDD disparities among TF, TM, and nonbinary people who have and have not accessed gender-affirming medical care.

Conclusions

To our knowledge, this is the largest national study to document within-group and between-group disparities in SUDDs among US transgender and cisgender adults. Transgender individuals in our study had significantly higher rates of SUDDs compared with cisgender individuals, a pattern that persisted when transgender and cisgender cohorts were compared across age groups and geographic areas. These findings highlight the need to ensure access to high-quality SUD treatment for transgender individuals as well as additional research to understand facilitators and barriers to SUD treatment engagement for this population. Such research can inform the development of novel public health interventions to prevent and treat SUD among transgender people in the United States.

Summary

A comprehensive analysis of a large national dataset reveals substantially higher rates of substance use disorder diagnoses (SUDDs) among transgender adults compared to their cisgender counterparts. This disparity is consistent across various demographic subgroups, highlighting a critical need for targeted interventions.

Study Findings

This study, utilizing data from the OptumLabs Data Warehouse, encompassed a significant sample size of transgender and cisgender adults. The results demonstrate a statistically significant elevation in the prevalence of nicotine, alcohol, and drug SUDDs within the transgender population. These findings suggest a substantial public health concern requiring focused attention and the development of culturally sensitive treatment strategies.

Methodology

Employing a cross-sectional design, the researchers analyzed de-identified claims data from a substantial national database encompassing millions of adults. A cohort of transgender adults was identified using a validated algorithm incorporating diagnostic codes, procedural codes, and hormonal data. A matched cisgender cohort was created for comparison. Statistical analysis included prevalence estimates and chi-squared tests to evaluate disparities across various demographic strata.

Results

The study confirmed a markedly higher prevalence of all SUDDs (nicotine, alcohol, and various drug types) among transgender adults compared to cisgender adults. This difference remained significant across age groups and geographic regions. Further analysis revealed a notably higher prevalence of SUDDs among transfeminine individuals compared to transmasculine individuals within the transgender cohort.

Discussion and Limitations

The study's findings underscore a significant disparity in SUDD prevalence, calling for improved access to and tailoring of treatment services for transgender individuals. The limitations include the reliance on diagnosed SUDs (potentially underestimating the true prevalence due to access barriers), the absence of race-specific data, and limitations in the algorithm used to identify transgender individuals, specifically the exclusion of nonbinary individuals who had not accessed gender-affirming care. Despite these limitations, the study provides compelling evidence of a critical public health issue requiring focused attention.

Conclusions

This research, while subject to limitations, presents robust evidence of elevated SUDD rates among transgender adults compared to cisgender adults. The persistent disparities across demographic subgroups necessitate improved access to and culturally sensitive SUD treatment programs for this population. Further research is warranted to refine understanding of these disparities and inform the development of effective interventions.

Summary

This study compared substance use disorder diagnoses (SUDDs) in a large sample of transgender and cisgender US adults. Transgender adults demonstrated significantly higher rates of nicotine, alcohol, and drug SUDDs compared to their cisgender counterparts. These findings highlight the need for culturally appropriate and effective SUDD interventions tailored to the transgender population.

Study Design and Methods

Researchers conducted a cross-sectional analysis utilizing the OptumLabs Data Warehouse (OLDW), a de-identified claims database encompassing commercially insured and Medicare Advantage enrollees. The study sample comprised approximately 15,637 transgender and 46,911 cisgender adults (≥18 years) enrolled in 2017. A 3:1 cisgender-to-transgender matching was implemented based on birth year and geographic region. SUDDs were identified using ICD-10 codes, categorizing disorders into alcohol, nicotine, cannabis, cocaine, opioid, and other SUDDs. Statistical analyses, including χ² tests, assessed differences in SUDD prevalence across various demographic subgroups.

Results

The study revealed a significantly higher prevalence of nicotine, alcohol, and drug SUDDs among transgender adults compared to cisgender adults. Transgender individuals exhibited a fourfold increase in polysubstance SUDDs. Further analyses showed statistically significant disparities across geographic regions and age groups, with consistent higher SUDD rates among transgender adults in all regions and across all age groups, except for nicotine SUDDs in older age groups. Subgroup analyses considering gender identity within the transgender population (transfeminine [TF] vs. transmasculine [TM]) indicated a markedly higher prevalence of most SUDDs among TF individuals. Cisgender males also displayed a higher prevalence of several SUDDs than cisgender females.

Discussion

This study represents the largest national investigation to date comparing SUDD disparities between transgender and cisgender adults. The substantial differences in SUDD prevalence underscore the critical need for targeted SUDD treatment interventions for transgender individuals. The study also highlighted regional disparities, with a higher prevalence of SUDDs among transgender individuals in the Northeast compared to other regions. Age-related disparities showed the highest burden of SUDDs (excluding nicotine) in the 18-25 age group for both transgender and cisgender adults. Gender identity within the transgender population also influenced SUDD prevalence, with TF individuals showing significantly higher rates than TM individuals.

Limitations

The study's limitations include the use of an algorithm to identify transgender individuals based on claims data which may underestimate the true prevalence, particularly for those who haven't accessed gender-affirming care. The lack of race-specific data prevented exploration of racial disparities. The algorithm also limited analysis by gender identity as many could not be classified as TF or TM. This exclusion primarily affected nonbinary individuals, a substantial portion of the transgender population. Therefore, the findings may not fully reflect the complete burden of SUDDs within the transgender community.

Conclusion

This study demonstrates significantly higher SUDD rates among transgender adults compared to their cisgender peers across various demographic factors. These findings strongly emphasize the urgent need for accessible and culturally sensitive SUDD treatment services specifically designed for the transgender population, particularly younger individuals and those identifying as transfeminine. Further research should investigate treatment accessibility, utilization, and effectiveness within this population to inform the development of improved interventions.

Summary

This study compared substance use disorder diagnoses (SUDDs) in a large group of transgender and cisgender adults in the US. Transgender adults showed significantly higher rates of nicotine, alcohol, and drug SUDDs than cisgender adults. This highlights the need for better, more inclusive SUDD treatment programs tailored to the transgender community.

Introduction

Transgender individuals face a higher risk of substance abuse, often using substances to cope with discrimination. While previous research exists, estimates of SUD vary widely due to limitations in sample size and methods. Many studies are geographically limited, rely on self-reported data, and focus on specific subgroups (younger people or those identifying as transfeminine). This study uses a large national database to provide a broader perspective and address these gaps.

Methods

Researchers analyzed data from the OptumLabs Data Warehouse (OLDW), a large database of health insurance claims. The study included approximately 74 million adults. A cohort of transgender adults was identified using a specific algorithm. A cisgender cohort, three times the size, was matched to the transgender group based on age and location. SUDDs were identified using ICD-10 codes. Data was analyzed using various statistical methods.

Results

The study included 15,637 transgender and 46,911 cisgender adults. Transgender individuals had significantly higher rates of nicotine, alcohol, and drug SUDDs. Cannabis was the most common drug SUDD among transgender individuals, while cannabis and opioid SUDDs were equally prevalent among cisgender individuals. Higher SUDD prevalence was found in transgender individuals across all geographic regions and age groups. Transfeminine (TF) individuals had significantly higher rates of all SUDDs compared to transmasculine (TM) individuals.

Discussion

This study provides the largest national look at SUDD disparities between transgender and cisgender adults. Transgender individuals experienced a significantly higher prevalence of SUDDs, particularly nicotine and cannabis. The disparities persisted across geographic regions and age groups. TF individuals had higher rates than TM individuals, echoing previous but smaller scale studies. These results support the need for better access to SUD treatment for transgender people, particularly targeted interventions for high-risk groups. Limitations include the use of a specific algorithm for identifying transgender individuals, which may miss some cases, and the absence of racial data, preventing exploration of racial disparities in SUDDs. The study focuses only on diagnosed SUDs, and may underestimate the true prevalence.

Conclusions

This large-scale national study confirms significantly higher rates of SUDDs among transgender individuals compared to their cisgender peers. The disparities are consistent across different demographics. This study stresses the importance of ensuring accessible and inclusive SUDD treatment for the transgender community and emphasizes the need for more research.

Summary

This study looked at how many transgender and cisgender adults in the US had problems with alcohol, drugs, and nicotine. It found that transgender adults had much higher rates of these problems than cisgender adults. This means we need better help for transgender adults with these issues.

Introduction

Transgender people sometimes use drugs or alcohol to deal with the stress of being mistreated. Studies show that many transgender people have these problems, but the numbers vary a lot. Most studies are small and focus on specific groups. This study used a large group of people across the whole country to get a better idea of the problem.

Methods

Researchers used information from a huge database of health records. They looked at records from 2017 for adults with health insurance. They carefully identified transgender people in the data using information on medical diagnoses and treatments. Then, they compared them to a group of cisgender people.

Cohort Identification and Stratification

To make sure their results were reliable, they only looked at people who had health insurance for the whole year and at least five medical visits. They found transgender adults using special codes in the records showing hormone use or surgeries. They then chose a group of cisgender adults that matched the transgender group in terms of age and where they lived.

Measures

The researchers looked for diagnoses of problems with alcohol, nicotine, cannabis, cocaine, and opioids. They also combined drug problems (except alcohol and nicotine) into one category. They looked at age, gender (male, female, transgender female (TF), transgender male (TM), or unknown), and where people lived.

Results

The study found that transgender adults were much more likely to have problems with nicotine, alcohol, and other drugs than cisgender adults. Transgender adults in the Northeast had the most problems. Young adults (18-25) had the most problems, except for nicotine, which was highest among older adults (61+). Transgender women had more problems than transgender men.

Discussion

This is the largest study ever done on this topic, showing that transgender adults have much higher rates of these problems. This highlights a need for better treatment options specifically designed for transgender people. The study also showed large differences in rates based on where people lived and their age. Older transgender adults had the most nicotine problems, while young adults had more issues with other substances. Transgender women had more problems than transgender men.

Limitations

The study had some limitations. It only included people with insurance, so it might not represent the whole transgender population. It also didn't include information about race, which may affect the results. Also, only some transgender individuals could be clearly classified as transgender male or female because the database only used limited information. This may affect the results, especially for transgender people who do not use hormones or have not had surgeries.

Conclusions

This important study shows a big problem with substance use among transgender adults. We need more access to good treatment and more research to figure out why this happens and how to stop it.