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Research Track
Oral Presentations
Kristin Stevenson, MD
Fellow
University of Wisconsin Department of Medicine - Division of Endocrinology, Diabetes, and Metabolism
University of Wisconsin Department of Medicine - Division of Endocrinology, Diabetes, and Metabolism
Nothing to disclose
Background : Determinants of health disparities in transgender Veterans are unclear. Transgender individuals in the community are less likely to be up-to-date on preventive care screening; this is unknown for Veterans. In 2011, the VA required all facilities to provide transgender healthcare services. This may have resulted in improved preventive screening. We hypothesize that transgender Veterans are less likely than non-transgender Veterans to be up-to-date on preventive screening. However, we also hypothesize that the percent up-to-date may have increased between 2010 and 2017.
Methods : Medical records of Veterans with any ICD-9/ICD-10 code consistent with transgender status who had an encounter in a VA facility in WI in 2010 or 2017 were reviewed. In each year, the proportion “up-to-date” on screening according to VA guidelines was determined for diabetes, hyperlipidemia, breast, cervical, and colon cancer. Prostate cancer and osteoporosis screening were also assessed. Differences were examined using Chi-Square tests (α = 0.05).
Results : Eighty-one transgender patients had an encounter in a VA facility in WI in 2010, compared with 128 in 2017. The percent up-to-date on diabetes screening was high (93.8% vs 89.6%, p = 0.48), and did not differ between years. Transgender women receiving hormone therapy also had a high rate of being up-to-date on cholesterol screening (98.1% vs 100%, p = 0.23), as did transgender men (100% vs 88.9%, p = 0.55). A large number of transgender women were screened for prostate cancer (73.6% vs 67.6%, p = 0.38). Screening for osteoporosis was low (8.64% vs 13.2%, p = 0.31). Transgender men were likely to be up-to-date on cervical cancer screening (88.9% vs 88.2%, p = 0.96). More transgender women were up-to-date on breast cancer screening in 2017 (20.9% vs 52.3%, p = 0.003), and there was a trend towards increased colon cancer screening (58.5% vs 72.6%, p = 0.15). Expected percent up-to-date based on published VA data for breast and colon cancer screening is 86% and 82%, respectively. Data regarding comparison of transgender patients to matched non-transgender controls is forthcoming.
Conclusions : Overall, the percent of transgender patients up-to-date on diabetes, cholesterol, and cervical cancer screening was high and generally consistent with published rates for the VA population. This was not the case for colon or breast cancer screening in 2011; however, this appeared to improve in 2017, coinciding with new VA policy that may have increased access to transgender healthcare services. Additional study is needed to further evaluate health disparities in this population.