title: Health Correlates of Criminal Justice Involvement in 4,793 Transgender Veterans.
abstract: OBJECTIVE
  Transgender (TG) persons are overrepresented in prison settings and in the U.S. veteran population. Health disparities studies of large populations of transgender people involved with the criminal justice system have not been published to date.
  
  
  METHODS
  We studied a large cohort of TG veterans who received care in Veterans Health Administration (VHA) facilities during 2007-2013 (n = 4,793) and a 3:1 matched control group of veterans without known TG identification (n = 13,625). Three hundred twenty six (n = 138 TG, 188 non-TG) had received VHA services in programs designed to address the needs of justice involved (JI) veterans. We linked patients in each of the three groups to their medical and administrative data.
  
  
  RESULTS
  TG veterans were more likely to be justice involved than controls (2.88% vs. 1.38%; P < .0001). Compared to non-TG JI veterans, TG JI veterans were more likely to have a history of homelessness (80% vs. 67%; P < .05) and to have reported sexual trauma while serving in the military (23% vs. 12%; P < .01). Significant health disparities were noted for TG JI veterans for depression, hypertension, obesity, posttraumatic stress disorder, serious mental illness, and suicidal ideation/attempts.
  
  
  CONCLUSIONS
  These data suggest that TG veterans experience a number of health risks compared to non-TG veterans, including an increased likelihood of justice involvement. TG veterans involved with the criminal justice system are a particularly vulnerable group and services designed to address the health care needs of this population, both while incarcerated and when in the community, should take these findings into account in the development of health screenings and treatment plans.
authors.affiliation: 1 Mountain Home Veterans Affairs Medical Center , Psychiatry Service, Johnson City, Tennessee.|2 Department of Psychiatry and Behavioral Sciences, East Tennessee State University , Quillen College of Medicine, Johnson City, Tennessee.
authors.forename: George R
authors.initials: GR
authors.lastname: Brown
authors.affiliation: 3 Office of Health Equity, Veterans Health Administration , Washington, D.C.
authors.forename: Kenneth T
authors.initials: KT
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D054624:Health Status Disparities; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011329:Prisoners / Q000706:statistics & numerical data*; D012742:Sex Offenses / Q000706:statistics & numerical data; D064890:Social Determinants of Health; D012959:Socioeconomic Factors; D063106:Transgender Persons / Q000706:statistics & numerical data*; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*
keywords: disparity; incarceration; justice; transgender; veteran