A Comparison of Physical and Mental Health Disparities By Race/Ethnicity and Income Among Transgender Adults: Analysis of a Statewide Survey

Background/Purpose

Transgender people are understudied in relation to health disparities. Few federal health surveys ask about gender identity in a way that captures transgender and gender non-conforming identities. Even less is known about differences in health disparities across subgroups of transgender individuals, such as people of color and low-income adults. With this background in mind, the present study utilizes statewide health data from a sample of over 400 transgender adults to explore whether health outcomes differ by race/ethnicity and by income. The hypothesis is that transgender people of color and low-income adults face increased health risks.

Methods

This project involved secondary data analysis of an online, statewide community-based survey of 417 transgender adults in the Rocky Mountain region. Survey questions were modeled on the CDC's Behavioral Risk Factor Surveillance System, with input from community organizations and transgender community members. The sample was recruited in 2014 through advertisement by LGBT organizations, health providers, colleges and universities, and religious communities.

Results

Almost half (45.3%, n=178) of this sample identified as women/transgender women, 30.5% (n=120) men/transgender men, and 18.3% (n=72) gender queer/gender fluid. The majority (88.4%, n=352) were White, and 8.8% (n=35) were multiracial. 6.8% (n=28) were Hispanic. Compared to CDC data for the state, the sample had high rates of asthma (26.7% compared to 14.7%), depression (63.4% to 18.2%), a physical, mental or emotional problem that limits activities (47.3% to 18.8%), and high blood pressure (31.8% to 26.3%).

Logistic and multiple regression models indicate that, after controlling for health insurance, age, and exercise, transgender people of color and those who had lower incomes generally faced poorer health outcomes. Transgender people of color were 2.2 times as likely as whites to have had asthma (p<.05) and 2.44 times as likely to have arthritis, gout, lupus, or fibromyalgia (p<.05). They were less likely to have been told by a health provider that they had depression (AOR=2.25, p<.01), although there were no differences by race for current depression. Those who had lower income were more likely to have been told by a health professional that they have high cholesterol (AOR=1.11, p<.05), COPD/emphysema/chronic bronchitis (AOR=1.38, p<.05) or anxiety AOR=1.12, p<.05). They were more likely to have current depression (AOR=1.32, p<.001), suicidal ideation (AOR=1.22, p<.001), or a suicide attempt in the past year (AOR=1.23, p<.05), and they had fewer days of general health (B=-0.12, p<.001), physical health (B=-0.78, p<.001), and mental health (B=-1.07, p<.001) in the past month. They reported more days when they couldn't do usual activities in the past month due to poor physical or mental health (B=-0.94, p<.001).

Conclusions:

Compared to the state population, this sample of transgender adults was at heightened risk for various health challenges, with transgender people of color and low-income adults experiencing additional health disparities. Findings indicate the importance of targeted prevention and intervention efforts with these two subgroups. There is a need for continuing research on this topic, particularly studies that use larger samples of transgender people of color and recruit participants from other regions of the country.