# Fewer screens, greater needs: housing insecurity and healthcare costs for transgender patients in a safety-net system

## TL;DR

Transgender patients are less likely to be screened for social needs but face higher risks like housing instability and healthcare costs.

## Contribution

This study reveals disparities in screening and social needs among transgender patients in a safety-net healthcare system.

## Key findings

- Transgender patients were screened less often than cisgender patients for health-related social needs.
- Among those screened, transgender patients had higher odds of housing instability and healthcare costs.
- Transgender patients also faced three times higher odds of interpersonal violence.

## Abstract

Routine screening for health-related social needs (HRSNs) is inconsistent, creating disparities in who gets identified and supported. Transgender patients, already facing structural stigma, may be especially affected.

We analyzed electronic health records from a large urban safety-net system (2018-2023). We identified 2639 transgender patients with at least one outpatient visit and created a ∼11:1 comparison cohort of 23 944 cisgender patients. Overall, 7.5% (n = 1997) completed a Social Needs Questionnaire (SNQ), including 1840 cisgender and 157 transgender patients. We compared screening rates using chi-square tests and assessed adjusted odds for HRSN with logistic regression.

Transgender patients were screened less often than cisgender patients (5.9% vs 7.7%, P = 0.001). Among those screened, they had more than twice the odds of housing instability, poor-quality housing, and healthcare costs. Odds for interpersonal violence were th3ree times higher. Findings were consistent in sensitivity analyses adjusting for age, insurance, and neighborhood.

Transgender patients were underscreened yet faced greater HRSNs. Standardized screening and expanded supports are critical to support transgender communities.