Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 1;4(2):e2036512.
doi: 10.1001/jamanetworkopen.2020.36512.

Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults

Jaclyn M W Hughto  1   2   3 , Emily K Quinn  4 , Michael S Dunbar  5 , Adam J Rose  6 , Theresa I Shireman  7   8 , Guneet K Jasuja  9   10   11
Affiliations

Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults

Jaclyn M W Hughto et al. JAMA Netw Open. .

Erratum in

Abstract

Importance: Substance use disorders are a major source of morbidity and mortality in the United States. National data comparing the prevalence of substance use disorder diagnoses (SUDDs) among transgender and cisgender individuals are lacking in the United States.

Objectives: To investigate the prevalence of SUDDs among transgender and cisgender adults and to identify within-group and between-group differences by age, gender, and geographic location.

Design, setting, and participants: This cross-sectional study used the OptumLabs Data Warehouse to analyze deidentified claims from approximately 74 million adults aged 18 years or older enrolled in commercial or Medicare Advantage insurance plans in 2017. A total of 15 637 transgender adults were identified based on a previously developed algorithm using a combination of International Classification of Diseases, Tenth Revision (ICD-10) transgender-related diagnosis and procedure codes and sex-discordant hormone prescriptions. A cohort of 46 911 cisgender adults was matched to the transgender cohort in a 3:1 ratio based on age and geographic location.

Main outcomes and measures: SUDDs, based on ICD-10 codes, were assessed overall and compared between transgender and cisgender cohorts and by geographic region (ie, Northeast, Midwest, South, and West); age groups (eg, 18-25, 26-30, 31-35 years), and gender (ie, transfeminine [TF; assigned male sex at birth, identify along feminine gender spectrum], transmasculine [TM; assigned female sex at birth, identify along masculine gender spectrum], male, and female).

Results: In this study of 15 637 transgender adults (4955 [31.7%] TM) and 46 911 cisgender adults (23 247 [50.4%] men), most (8627 transgender adults [55.2%]; 51 762 cisgender adults [55.2%]) were aged between 18 and 40 years, and 6482 transgender adults (41.5%) and 19 446 cisgender adults (41.5%) lived in the South. Comparing transgender to cisgender groups, significant differences were found in the prevalence of a nicotine (2594 [16.6%] vs 2551 [5.4%]; P < .001), alcohol (401 [2.6%] vs 438 [0.9%]; P < .001), and drug (678 [4.3%] vs 549 [1.2%]; P < .001) SUDDs. Among transgender adults, cannabis was the most prevalent drug SUDD (321 [2.1%]), followed by opioid SUDD (205 [1.3%]) and cocaine SUDD (81 [0.5%]), whereas among cisgender adults, cannabis and opioid SUDDs were equally prevalent (cannabis, 186 [0.4%]; opioid, 207 [0.4%]), followed by cocaine SUDD (59 [0.1%]).

Conclusions and relevance: In this study, the prevalence of SUDDs was significantly elevated among transgender adults relative to their cisgender peers. These findings underscore the need for culturally tailored clinical interventions to treat substance use disorder in transgender populations.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Dunbar reported receiving personal fees from the National Institutes of Health outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Frequency of Substance Use Disorder Diagnoses (SUDDs) by Age Among US Transgender (n = 15 637) and Cisgender (n = 46 911) Adults, 2017
Drug SUDD includes cannabis, cocaine, opioids, and other drugs, including stimulants, hallucinogens, and sedatives.
See this image and copyright information in PMC

References

    1. Coulter RW, Blosnich JR, Bukowski LA, Herrick AL, Siconolfi DE, Stall RD. Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults. Drug Alcohol Depend. 2015;154:251-259. doi:10.1016/j.drugalcdep.2015.07.006 - DOI - PMC - PubMed
    1. Rowe C, Santos G-M, McFarland W, Wilson EC. Prevalence and correlates of substance use among trans female youth ages 16-24 years in the San Francisco Bay Area. Drug Alcohol Depend. 2015;147:160-166. doi:10.1016/j.drugalcdep.2014.11.023 - DOI - PMC - PubMed
    1. Reisner SL, Biello KB, White Hughto JM, et al. . Psychiatric diagnoses and comorbidities in a diverse, multicity cohort of young transgender women: baseline findings from project LifeSkills. JAMA Pediatr. 2016;170(5):481-486. doi:10.1001/jamapediatrics.2016.0067 - DOI - PMC - PubMed
    1. Keuroghlian AS, Reisner SL, White JM, Weiss RD. Substance use and treatment of substance use disorders in a community sample of transgender adults. Drug Alcohol Depend. 2015;152:139-146. doi:10.1016/j.drugalcdep.2015.04.008 - DOI - PMC - PubMed
    1. Jun H-J, Webb-Morgan M, Felner JK, et al. . Sexual orientation and gender identity disparities in substance use disorders during young adulthood in a United States longitudinal cohort. Drug Alcohol Depend. 2019;205:107619. doi:10.1016/j.drugalcdep.2019.107619 - DOI - PMC - PubMed

Publication types