Correlates of hazardous alcohol drinking among trans and non-binary people in Canada: A community-based cross-sectional study

Transgender and non-binary people (TGNB) have a higher rate of heavy episodic drinking than cisgender people; however, extant knowledge about predictors of hazardous alcohol drinking (HAD) among different TGNB groups is limited. This study examined predictors of HAD in a national sample of TGNB people in Canada. Logistic regression models were fit to examine the effects of 1) minority stressors and 2) stress-buffering factors on the likelihood of HAD, stratified by gender, among 2324 TGNB individuals from the Trans PULSE Canada survey, a cross-sectional survey conducted in 2019 among trans and non-binary people aged 14+ in Canada. Almost 17% of participants reported past-year HAD. Lifetime day-to-day and lifetime major discrimination were associated with higher odds of HAD in the full sample [(AOR=1.37, 95% CI: 1.30, 1.44) and (AOR=1.69, 95% CI: 1.55, 1.86) respectively], and across all gender groups. Social support was associated with lower odds of HAD in trans men, non-binary people assigned female at birth (NB-AFAB), and non-binary people assigned male at birth (NB-AMAB) groups, but with higher odds of HAD in the trans women group. Misgendering was associated with lower odds of HAD in trans men and NB-AFAB, but higher odds of HAD in trans women and NB-AMAB. Mixed effects of gender distress, gender positivity, and gender-affirming medical care were also reported across groups. The study provided a more detailed understanding of the predictors of HAD across four TGNB groups. Public health interventions should focus on structural discrimination and social support for TGNB people. •We examined the effects of minority stressors and stress-buffering factors on hazardous drinking (HAD) in four trans and non-binary (TGNB) groups.•Lifetime day-to-day and lifetime major discrimination were associated with higher odds of HAD in all four TGNB groups.•Mixed effects of social support, misgendering, gender distress, gender positivity, and gender-affirming care were reported across groups.•TGNB groups differred in the associations between minority stressors, stress-buffering factors, and past-year HAD.•Study calls for interventions to reduce structural discrimination and improve social support to mitigate the impact of HAD on TGNB people.