Housing Instability Characteristics Among Transgender Veterans Cared for in the Veterans Health Administration, 2013–2016

Abstract

<i>Objectives.</i> To characterize housing instability among transgender veterans using Veterans Health Administration (VHA) health care in the United States.<i>Methods.</i> We used administrative data on veterans screened for housing instability from 2013 to 2016; participants included 5717 transgender veterans and 17 133 cisgender veterans. We defined housing instability by a positive screen or VHA Homeless Program use. We identified gender from medical records, reflecting either birth sex or gender identity. We identified transgender identity through transgender-related <i>International Classification of Diseases, Ninth Revision</i> and <i>Tenth Revision</i> codes. A multiple logistic regression assessed the association of transgender identity with housing instability.<i>Results.</i> Prevalence of housing instability was nearly 3 times higher among transgender veterans than among cisgender veterans (19.9% vs 6.7%; <i>P</i> < .001). The difference persisted when we adjusted for sociodemographics (adjusted odds ratio = 2.32; 95% confidence interval = 2.09, 2.57). Transgender veterans experiencing housing instability were more likely than cisgender veterans to be women, younger, unmarried, and White.<i>Conclusions.</i> Transgender veterans experience housing instability more frequently than do cisgender veterans. An increased focus on transgender identity is critical for reducing veteran homelessness.