Abstract
BACKGROUND: 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. OBJECTIVE: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.