By Rachel Gurevich

(Reuters Health) – Transgender military veterans do not have worse health than cisgender veterans, a recent U.S. study suggests.

Transgender people have long served in the U.S. military but were banned from serving openly until 2016, when President Barack Obama’s administration lifted the ban. President Donald Trump’s administration has sought to reinstate the ban, citing civilian research indicating that transgender people require more medical care.

“We realized that, for the first time, we had representative data” to see if transgender soldiers do in fact run up higher healthcare bills after they finish their military service, study coauthor Janelle Downing of the School of Public Health at the University of South Carolina in Columbia told Reuters Health by email.

Her team analyzed data from the Behavioral Risk Factor Surveillance System, an annual telephone health survey managed by the U.S. Centers for Disease Control and Prevention.

Overall, they researchers had survey responses collected between 2014 and 2016 from just over 500,000 adults. The total included 66,677 cisgender veterans, 320 transgender veterans, 448,644 cisgender civilians, and 1,898 transgender civilians.

Reporting in Health Affairs, the authors say they expected transgender veterans to have worse health than cisgender veterans. “(But) in contrast to our primary hypothesis and prior research, we found few differences in health among veterans,” they write.

The only significant difference was that transgender veterans were more likely to have at least one disability compared to cisgender veterans, despite similar access to health care.

The pattern was different for civilians. Transgender civilians were less likely than cisgender civilians to be employed, less likely to have health insurance coverage, and more likely to report poor health.

The finding that transgender veterans were healthier than transgender civilians suggests that “military service (is) a potentially independent social determinant of health,” the authors write.

The study has limitations. For example, the number of transgender participants was small. Also, telephone surveys miss people who don’t have phones. In addition, active duty military personnel were not included in the survey.

Still, the large-scale collection of data from the general public suggests that the health risks of transgender service have been exaggerated, Nathaniel Frank, Director of the What We Know Project at Cornell University’s Center for the Study of Inequality in Ithaca, New York, told Reuters Health by email.

“Transgender individuals face substantial discrimination,” said Sabra L. Katz-Wise of the Harvard T. H. Chan School of Public Health in Boston, who specializes in the study of transgender adolescent and young adult health. “Efforts to ban them from serving in the U.S. military are just one example of this discrimination,” she said.

“Furthermore, the lack of health disparities between transgender and cisgender veterans compared to civilians speaks to the effectiveness of healthcare access in reducing these disparities,” Katz-Wise, was not involved in the study, told Reuters Health by email.

Downing hopes military policymakers will realize that research on civilians is not necessarily “generalizable to transgender veterans.”

SOURCE: Health Affairs, online July 9, 2018.