Prevalence of modifiable risk factors for Alzheimer’s disease and related dementias, and association with cognitive disability among transgender and gender non‐binary adults in the U.S.: BRFSS 2019

Abstract

AbstractBackgroundSubjective cognitive impairment (SCI) may represent an early sign of Alzheimer’s disease and related dementias (ADRD). Little is known about prevalence of SCI among people identifying as transgender men/women, or gender non‐binary (TNB). The Behavioral Risk Factor Surveillance System (BRFSS) defines cognitive disability as serious difficulty concentrating, remembering, or making decisions due to a health condition. Using report of cognitive disability as a surrogate for SCI, we aimed to: 1) characterize rates of morbidities considered modifiable risk factors for ADRD by gender identity, and 2) explore interactions between morbidities, cognitive disability and gender identity.MethodWe analyzed 2019 BRFSS data from 31 US states and Guam administering the optional sexual orientation and gender identity (SOGI) module. Chi‐squared tests characterized unadjusted associations between gender identity and health conditions (heart attack, stroke, diabetes, angina/coronary heart disease, and depression). Adjusted associations were investigated using logistic regression models. Models included cognitive disability as outcome, with gender identity, health condition, and age group as covariates, and interaction between gender identity and health condition. Likelihood ratio tests evaluated for interaction significance. Multiple correction controlled for false discovery rate at 5%.ResultOf respondents providing a gender identity (n=231,414), 955 identified as TNB. Rates of depression were significantly higher for TNB respondents (37%) compared to cisgender (i.e. non‐TNB) counterparts (19.2%). Additionally, reports of cognitive disability were significantly higher in TNB respondents (24.7%) compared to cisgender counterparts (10.5%). Adjusted odds of cognitive disability with depression were highest for transgender men (aOR=11.48; 95% CI=20.70‐6.37) and cisgender men (aOR=9.22; 95% CI=9.65‐8.81), followed by cisgender women (aOR=7.50; 95% CI=7.79‐7.23), transgender women (aOR=4.71; 95% CI=7.93‐2.79), and non‐binary respondents (aOR=3.48; 95% CI=6.44‐1.88). Overall, TNB respondents were younger, with most between ages 18‐44 years (48.3%), compared to cisgender counterparts (26.8%).ConclusionRates of depression and cognitive disability were significantly higher for TNB groups compared to cisgender counterparts. Interestingly, interaction analyses suggested that men, be it transgender or cisgender, demonstrated greatest cognitive disability associated with depression compared to other groups. Future directions include investigating psychosocial facets of gender identity and cognitive health, along with tailored interventions addressing modifiable risk factors and ADRD screening.