Health and Cardiometabolic Disease in Transgender Adults in the United States: Behavioral Risk Factor Surveillance System 2015

Abstract

Context: Little is known about the health of transgender adults in the United States, a growing population. There have been no large reports examining differences in health status and cardiometabolic disease in subgroups of transgender adults [female-to-male (FTM), male-to-female (MTF), and gender nonconforming (GNC)] in the United States.

Objective: Compare the health status and prevalence of cardiometabolic disease among specific subgroups of transgender adults (FTM, MTF, GNC) with those of cisgender adults in the United States.

Design: Secondary data analysis based on the 2015 Behavioral Risk Factor Surveillance System survey.

Setting: The 22 states in the United States that asked about transgender identity.

Participants: Noninstitutionalized adults age ≥18 years who reside in the United States, identified through telephone-based methods.

Main outcome measures: Data were extracted for respondents who answered the transgender identity question. Weighted percentages are given for all measures. Adjusted odds ratios (ORs) are reported for health status and cardiometabolic disease measures.

Results: FTM adults have a higher odds of being uninsured than both cisgender women [OR 3.8; 95% confidence interval (CI), 2.1 to 7.1] and cisgender men (OR 2.5; 95% CI, 1.4 to 4.7). MTF adults have a higher odds of reporting myocardial infarction than cisgender women (OR 2.9; 95% CI, 1.6 to 5.3) but not cisgender men.

Conclusions: There are significant differences in health status measures and cardiometabolic health between subgroups of transgender adults and cisgender adults. There is a need for additional research to understand the societal and medical (e.g., hormone therapy) effects on these outcomes.

Keywords: gender nonconforming; health insurance; myocardial infarction; transgender.

Figure 1.

Odds of self-reported health status measures among transgender subgroups vs cisgender men and women. Forest plots depicting adjusted ORs and lower 95% confidence intervals (LCIs) and upper 95% confidence intervals (UCIs) for health status measures among (a) FTM vs cisgender men and women, (b) MTF vs cisgender men and women, (c) GNC-M vs cisgender men, and (d) GNC-F vs cisgender women. Comparisons on the basis of natal sex are depicted with a solid line (FTM vs Cis F, MTF vs Cis M, GNC-M vs Cis M, GNC-F vs Cis F), and comparisons on the basis of gender identity are depicted with a dashed line (FTM vs Cis M, MTF vs Cis F). Cis F, cisgender female, female sex and female gender identity; Cis M, cisgender male, male sex and male gender identity.

Figure 2.

Odds of self-reported cardiometabolic disease among transgender subgroups vs cisgender adults. Forest plots depicting adjusted ORs and lower 95% confidence intervals (LCIs) and upper 95% confidence intervals (UCIs) 95% CIs for cardiometabolic disease measures among (a) FTM vs cisgender men and women, (b) MTF vs cisgender men and women, (c) GNC-M vs cisgender men, and (d) GNC-F vs cisgender women. Comparisons on the basis of natal sex are depicted with a solid line (FTM vs Cis F, MTF vs Cis M, GNC-M vs Cis M, GNC-F vs Cis F), and comparisons on the basis of gender identity are depicted with a dashed line (FTM vs Cis M, MTF vs Cis F). Cis F, cisgender female, female sex and female gender identity; Cis M, cisgender male, male sex and male gender identity.