Impact of Social Determinants of Health on Atherosclerotic Cardiovascular Disease in Transgender Individuals.

OBJECTIVE

To compare the prevalence of social determinants of health (SDOH) and atherosclerotic cardiovascular disease (ASCVD) in transgender and gender-diverse (TGD) with cisgender (CG) individuals and investigate the association of transgender status with ASCVD events, adverse SDOH, and ASCVD risk factors.

PARTICIPANTS AND

METHODS

Retrospective serial cross-sectional data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance Survey were used to quantify the age-adjusted prevalence of self-reported ASCVD events, composite risk factor-based cardiovascular health index metrics, and SDOH measures. These measures were compared between TGD and CG individuals. Multivariable-adjusted logistic regression models were used to assess the association of transgender identity with ASCVD accounting for SDOH measures and ASCVD factors.

RESULTS

Among 834,012 respondents, 3669 (0.4%) identified as TGD and 830,343 (99.6%) as CG. The TGD individuals were more likely to have an annual income of less than $15,000 (440 [12.0%] vs 63,936 [7.7%]), less than high school education (748 [20.4%] vs 102,963 [12.4%]), less home ownership (1,501 [40.9%] vs 516,473 [62.2%]), higher unemployment (781 [21.3%] vs 99,641 [12.0%]), and less health care access (895 [24.4%] vs 114,587 [13.8%]) compared with CG individuals (P<.05 for all). Although the cardiovascular health index score was similar between the 2 populations (3.56 vs 3.53), TGD individuals had a higher prevalence of tobacco use (224 [6.1%] vs 32,383 [3.9%]), reported myocardial infarction (220 [6.0%] vs 37,365 [4.5%]), and reported stroke (143 [3.9%] vs 19,928 [2.4%]).

CONCLUSION

Individuals who identify as TGD have a higher prevalence of deleterious SDOH and ASCVD events. The association of TGD status with ASCVD events is driven primarily by deleterious SDOH and ASCVD risk factors in this population.