Housing As a Social Determinant of Health Among Communities of Trans-Experience: Results from the 2015 United States Transgender Survey

background: Communities of trans-experience (COT) face inordinate rates of homelessness, eviction and adverse health outcomes, yet the examinations of these associations have remained largely under explored. Understanding the health and mental health related impact of housing on COT present significant public health and clinical practice implications. methods: Data was derived from the 2015 United States Transgender Survey (USTS), the largest known survey among COT (N=27,490). These analyses examine the prevalence of housing status and its relationship to health outcomes. Bivariate analyses and multivariate regression were conducted to test the associations between demographic characteristics, housing status and health related outcomes (psychological distress in the past 30 days, past year suicide attempt and self-rated health). results: The mean age of the sample was 31; 82.5% identified as White, 2.9% as Black, 5.3% as Latino/Hispanic and 9.3% as Other; 31.1% were at/ near poverty level. In the past year, 6% reported being homeless, 0.8% experienced eviction and 2% experienced both. The odds of psychological distress during the past 20 days was greater among those who had been evicted in the past year (AOR=1.59, 95% CI 1.21, 2.11), experienced homelessness in the past year (AOR=2.41, 95% CI 2.18, 2.68) and those who experienced both (AOR=2.76, 95% CI 2.32, 3.29) compared to those who were stably housed. Eviction in the past year (AOR=0.63, 95% CI 0.47, 0.83), homelessness in the past year (AOR=0.53, 95% CI 0.48, 0.59) or experiencing both in the past year (AOR=0.49, 95% CI 0.21, 0.59) were all associated with decreased odd of self-reporting very good or excellent health. Increased likelihood of suicide attempt in the past year was associated with being homeless in the past year (AOR=2.50, 95% CI 2.17, 2.87) or having been evicted and homeless in the past year (AOR=3.39, 95% CI 2.17, 2.87).  conclusion: Results from these analyses support evidence of housing as a social determinant of health and its relationship to health inequities among systematically disenfranchised populations specifically communities of trans-experience. For social work and medical practitioners alike, these findings reinforce the need to assess housing status as it relates to optimal mental health and well-being. For scholars, these findings underscore the urgent need for further research to inform the development of empirically grounded interventions as well as housing policy.