Health-related quality of life among transgender and gender diverse adults with epilepsy: Florida behavioral risk factor surveillance system 2017-2019.

The relationships of epilepsy and transgender and gender-diverse (TGD) identities with health-related quality of life (HRQOL) have been studied independently, but their intersectional influence remains unstudied. This study examined the effects of epilepsy, TGD identity, and their interaction on HRQOL. We analyzed cross-sectional data from Florida's Behavioral Risk Factor Surveillance System (BRFSS) from 2017 to 2019, the only state-years including epilepsy and TGD identity variables. Measures included demographics, gender identity, self-reported epilepsy diagnosis, and HRQOL indicators from the Healthy Days Measure: self-rated general health (5-point Likert), and number of poor physical health days, poor mental health days, and activity-limitation days in the past 30 days. Ordinal and negative binomial regressions estimated associations and interaction effects, adjusting for confounders. Among the weighted sample representing 17.09 million adults aged 18+, 1.4% reported an epilepsy diagnosis, and 0.4% identified as TGD. Of those with epilepsy, 1.9% identified as TGD. Epilepsy was associated with poorer HRQOL across all indicators, and TGD identity with greater activity limitations. Transgender and gender diverse people with epilepsy (TGDPWE) reported worse general health (aOR = 0.42 [95%CI, 0.32-0.55]), poorer mental health (aIRR = 3.53 [95%CI, 1.58-8.00]) and greater activity limitations (aIRR = 4.55 [95%CI, 2.10-9.85]) than either group alone. Epilepsy and TGD identity may have compounding effects on HRQOL, consistent with structural, sociopolitical, and healthcare inequities affecting TGD communities. Findings reinforce the importance of accessible, gender-affirming clinical approaches and supportive policies addressing barriers in epilepsy care. Limitations in BRFSS data necessitate safer, community-informed population data on neurological health and gender identity to guide equitable public health action.