Subjective cognitive decline and unmet care needs highest among transgender women: A comparison of subjective cognitive decline and related limitations among transgender communities in the U.S.

Abstract

AbstractBackgroundThe transgender population is composed of subgroups that are diverse in gender identity (e.g., transgender women [TW], transgender men [TM], nonbinary [NB] individuals). Research investigating Alzheimer’s disease and related dementias (ADRD) among transgender adults is limited and no study has delineated the factors associated with the brain health of TW, TM, or NB adults. Compared to their cisgender peers, transgender adults are more likely to report subjective cognitive decline (SCD), which may be one of the first clinical manifestations of ADRD. It remains unclear if SCD prevalence and related limitations vary by transgender subgroups.Method2015‐2020 Behavioral Risk Factor Surveillance System data, representing 39 U.S. states that assessed SCD (confusion/memory loss happening more often/getting work over previous 12 months) and self‐reported gender identity were used to examine differences in SCD prevalence and SCD‐related limitations (activities of daily/independent living) by transgender subgroups, TW (n = 442), TM (n = 298), and NB (n = 183). Age‐adjusted odds ratios (OR) along with 95% confidence intervals (CI) were calculated to investigate group differences in prevalence of SCD. Separate analyses compared SCD‐associated limitations, demographics, and health characteristics across study groups among participants reporting SCD.ResultSCD prevalence was highest among NB (21.3%), followed by TW (16.3%) and TM (14.1%). After accounting for age, subgroup differences remained; the odds of SCD were 1.6 times higher among TW compared to TM (95% CI: 1.1‐2.4, p = 0.012). Among those with SCD, TW were less likely to receive help they needed with day‐to‐day activities when compared to TM (OR = 7.9; 95% CI: 0.1–0.2, p<0.001) and NB (OR = 5.0; 95% CI: 0.1–0.4, p = 0.001); and TW were more likely to be deaf (OR = 4.2; 95% CI: 1.7‐10.1, p = 0.002) and have asthma (OR = 2.8; 95% CI: 1.4‐5.7, p = 0.005) when compared to NB adults. No other SCD‐related limitation, demographic, or health differences were found.ConclusionHealth and social inequities are not uniformly experienced across transgender subgroups, and it is important to understand how these factors uniquely impact the brain health of TW, TM, and NB adults. There is an urgent need for ADRD and cognitive aging studies in this population.