Physical Health Disparities Research Articles

Divergent Immigrant Health Trajectories: Disparities in Physical Health Using a Multidimensional Conceptualization of Legal Status

Immigrant health research demonstrates that foreign-born individuals generally experience lower morbidity rates relative to native-born individuals. However, this research often overlooks structural factors that influence the immigrant experience, such as legal status. The present study examines legal status as a multidimensional and dynamic characteristic that shapes immigrant health over time. I use two waves of the New Immigrant Survey (n = 3550) to assess if three dimensions of legal status — initial documentation classification, legal permanent residence (LPR) admission category, and US citizenship — predict likelihoods of reporting a chronic condition among a sample of immigrants who attained LPR. Results indicate that each of the three dimensions of legal status predicted health. Immigrants who obtained US citizenship improved their relative health over time, while immigrants with previous temporarily documented, undocumented, legalization, or refugee experience exhibited persistent disadvantage in the hierarchy of immigrant health. Findings demonstrate that the sociopolitical context continually shapes the physical health of immigrants, and a dynamic and multidimensional conceptualization of legal status can expose previously obscured disparities in the overarching pattern of an immigrant health advantage.

Quality of Life and Psychosocial Well-Being among Intersex-Identifying Individuals in Puerto Rico: An Exploratory Study.

Intersex is an umbrella term used to describe the diversity or differences in the characteristics of physical sexual development. Approximately 1.7% of the population are born intersex, and 1 in every 2000 babies at birth presents genital variation. Unfortunately, there is a lack of research on the health of intersex-identifying persons in Latin America. This study aimed to document experiences of discrimination and violence among self-identifying intersex individuals in Puerto Rico and to determine if there is a significant difference in the quality of life, psychological well-being, and social well-being between intersex-identifying and endosex individuals. This was a quantitative method pilot study with a cross-sectional approach and exploratory comparative group design. An online survey was used, where a total of 12 self-identifying intersex adult participants were recruited, and 126 endosex adult participants served as a comparative group. The findings show that 83% of the participants reported experiences of discrimination and different types of violence due to their intersexuality. There was a significant difference between the intersex-identifying and endosex groups in psychological well-being, including in three of its dimensions (positives relations, autonomy, and environmental mastery). However, there were no significant differences between the groups in quality of life or social well-being. The findings of this study provide a preliminary understanding of the health disparities of intersex-identifying individuals in Puerto Rico and suggest the need for more profound research, especially the inclusion of other Caribbean and Hispanic countries. The findings also preliminarily imply the need for local and global interventions to reduce physical and mental health disparities and to improve health, quality of life, and well-being among intersex-identifying individuals.

Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association.

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Intergenerational residential school attendance and increased substance use among First Nation adults living off-reserve: An analysis of the aboriginal peoples survey 2017.

The Truth and Reconciliation Commission of Canada (TRCC) published 94 Calls to Action in 2015 to address long-term, intergenerational effects of the residential school system, highlighting the pervasive impact of colonialism on the wellbeing of Indigenous peoples in Canada. Indeed, research with Indigenous populations in Canada has captured that prior experiences of residential schools contributes to the intergenerational transmission of mental and physical health disparities. Despite these studies, further research is needed that contextualizes the influence of residential schools within broader frameworks that consider Indigenous social determinants of health in Canada. As such, the purpose of the present study was to examine patterns of substance use and mental and physical health among individuals with a history of residential school attendance (RSA) and individuals reporting parent or two-generation (parent and grandparent) RSA. Data from the Aboriginal Peoples Survey (2017), involving 10,030 First Nations individuals living off reserve, were analyzed. Self-reported mental and physical health scores were significantly lower among those had attended residential schools, whose parents attended residential schools, and whose grandparents attended residential schools, when compared to those who did not. Further, family RSA was associated with increased substance use among participants, though the findings were variable based on sex and specific substance analyzed. Meanwhile, individual and family RSA was not associated with increased likelihood of a mental health diagnosis. These findings provide additional support for how both parental and two-generation family histories of RSA are associated with individual physical and mental health outcomes. Further, these findings articulate the need for the TRCC's Calls to Action to be actually implemented, including community-based approaches that harness the strength of Indigenous people and communities who aim to close the gap in these health disparities for their children and families.

Examining neighbourhood-level disparities in Black, Latina/o, Asian, and White physical health, mental health, chronic conditions, and social disadvantage in California

ABSTRACT Racial/ethnic minority individuals in the U.S. experience numerous health disparities versus Whites, often due to differences in social determinants. Yet, limited large-scale research has examined these differences at the neighbourhood level. We merged 2021 PLACES Project and 2020 American Community Survey data across 3,211 census tracts (neighbourhoods) defined as majority (>50%) Black, Latina/o, Asian or White. T-tests and hierarchical linear regressions were used to examine differences and associations between neighbourhoods on key health (general health, mental health, obesity, diabetes, cancer, coronary heart disease, chronic obstructive pulmonary disease, stroke), and social outcomes (income, unemployment, age, population density). Results indicated that minority neighbourhoods in California exhibited stark health and social disparities versus White neighbourhoods, displaying worse outcomes on nearly every social and health variable/condition examined; particularly for Black and Latina/o neighbourhoods. Moreover, regression findings revealed that, after considering income, unemployment, and population density, (1) fair/poor mental health and higher percentages of Black, Latina/o and Asian residents in neighbourhoods independently associated with greater neighbourhood fair/poor physical health, and (2) fair/poor mental health significantly associated with greater prevalence of obesity and COPD. This study thus underscores the need to address the profound health and social disparities experienced by minority neighbourhoods for more equitable neighbourhoods.

Physical health disparities and severe mental illness: A longitudinal comparative cohort study using hospital data in Northern Ireland.

People with severe mental illness (SMI) die prematurely, mostly due to preventable causes. To examine multimorbidity and mortality in people living with SMI using linked administrative datasets. Analysis of linked electronically captured routine hospital administrative data from Northern Ireland (2010-2021). We derived sex-specific age-standardised rates for seven chronic life-limiting physical conditions (chronic kidney disease, malignant neoplasms, diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure, myocardial infarction, and stroke) and used logistic regression to examine the relationship between SMI, socio-demographic indicators, and comorbid conditions; survival models quantified the relationship between all-cause mortality and SMI. Analysis was based on 929,412 hospital patients aged 20years and above, of whom 10,965 (1.3%) recorded a diagnosis of SMI. Higher likelihoods of an SMI diagnosis were associated with living in socially deprived circumstances, urbanicity. SMI patients were more likely to have more comorbid physical conditions than non-SMI patients, and younger at referral to hospital for each condition, than non-SMI patients. Finally, in fully adjusted models, SMI patients had a twofold excess all-cause mortality. Multiple morbidities associated with SMI can drive excess mortality. While SMI patients are younger at referral to treatment for these life-limiting conditions, their relatively premature death suggests that these conditions are also quite advanced. There is a need for a more aggressive approach to improving the physical health of this population.

Comprehensive systematic review and meta-analysis on physical health conditions in lesbian- and bisexual-identified women compared with heterosexual-identified women.

Sexual minority individuals experience discrimination, leading to mental health disparities. Physical health disparities have not been examined to the same extent in systematic reviews so far. To provide a systematic review and, where possible, meta-analyses on the prevalence of physical health conditions in sexual minority women (i.e. lesbian- and bisexual-identified women) compared to heterosexual-identified women. The study design is a systematic review with meta-analyses. A systematic literature search in MEDLINE, EMBASE, CENTRAL, CINAHL, and Web of Science databases was conducted on epidemiologic studies on physical health conditions, classified in the Global Burden of Disease project, published between 2000 and 2021. Meta-analyses pooling odds ratios were calculated. In total, 23,649 abstracts were screened and 44 studies were included in the systematic review. Meta-analyses were run for arthritis, asthma, back pain, cancer, chronic kidney diseases, diabetes, headache disorders, heart attacks, hepatitis, hypertension, and stroke. Most significant differences in prevalence by sexual identity were found for chronic respiratory conditions, especially asthma. Overall, sexual minority women were significantly 1.5-2 times more likely to have asthma than heterosexual women. Furthermore, evidence of higher prevalence in sexual minority compared to heterosexual women was found for back pain, headaches/migraines, hepatitis B/C, periodontitis, urinary tract infections, and acne. In contrast, bisexual women had lower cancer rates. Overall, sexual minority women had lower odds of heart attacks, diabetes, and hypertension than heterosexual women (in terms of diabetes and hypertension possibly due to non-consideration of pregnancy-related conditions). We found evidence for physical health disparities by sexual identity. Since some of these findings rely on few comparisons only, this review emphasizes the need for routinely including sexual identity assessment in health research and clinical practice. Providing a more detailed picture of the prevalence of physical health conditions in sexual minority women may ultimately contribute to reducing health disparities.

The Intersection of Stress, Health, and Health Care Opportunities for Appalachian Transgender and Nonbinary People: An Interpretative Phenomenological Analysis

Transgender or nonbinary (TNB) individuals in the United States South experience higher rates of physical and mental health disparities when compared to their cisgender counterparts. Societal, interpersonal, and individual stigmas contribute to these disparities by increasing the levels of stress in the TNB population, which is a primary factor in higher morbidity and mortality. However, there is a paucity of research examining the impact of these stigmas on health through the lived experiences of TNB people living in Appalachia. An interpretive phenomenological analysis (IPA) research design was used to collect and analyze semi-structured interviews with TNB individuals living in Appalachia. Transcribed interviews were analyzed repeatedly by two analysts to identify emergent themes which focused on understanding an individual's lived experiences through interpretation. Ten participants from four Appalachian states within three Appalachian sub-regions participated in this study. Three shared healthcare themes were identified: experiences of stigma related to gender, the impact of stigma on personal wellbeing and perception of health, and the need for affirming TNB healthcare services. Respondents noted that chronic stress factors such as continual and compounding experiences of stigma and discrimination, stemming from religion or lack of affirming providers, negatively impacted their health. TNB individuals living in Appalachia experience chronic societal, interpersonal, and individual stressors that negatively impact their health. By addressing the stigmas, public health leaders, policymakers, and providers can improve access to health care and the health and quality of life of Appalachian TNB people.

Unequal outcomes: The effects of the COVID-19 pandemic on mental health and wellbeing among Hispanic/Latinos with varying degrees of 'Belonging'.

The COVID-19 pandemic has brought disparities in mental and physical health faced by ethnic minorities to the forefront. In the U.S., Hispanic/Latino communities are plagued by elevated rates of psychiatric conditions and trauma. Exacerbating this burden, common discourse often implicates Hispanic/Latino ethnicity as a causal factor, despite clear evidence of systemic causes, including lack of access to resources, and discrimination. To parse apart Hispanic/Latino ethnicity from determinants of wellbeing (such as trauma, financial status, and loneliness), we examined mental and physical health during COVID-19 via an online, anonymous survey available in both English and Spanish. We examined wellbeing across three participant groups, including two groups of Hispanic/Latino adults with varying degrees of 'belonging' to the dominant culture in their country of residence: Hispanic/Latino individuals living in Spanish-speaking and/or Central or Latin American countries (Group 1), Hispanic/Latino individuals living in the U.S. (Group 2), and non-Hispanic/Latino individuals living in the U.S. (Group 3). Results demonstrated there were significant differences between groups in specific aspects of wellbeing. Most importantly, results showed Hispanic/Latino ethnicity does not significantly predict psychosocial wellbeing or psychosis risk, and identified several predictors of these outcomes, including U.S. residence, trauma, loneliness, and age. Our results demonstrate that Hispanic/Latino ethnicity itself is not a causal factor of poor psychosocial wellbeing or elevated psychosis risk and instead identify several social and systemic causal factors commonly faced by Hispanic/Latino Americans. We suggest that language reporting on minority mental health acknowledge systemic factors as contributing to poor outcome rather than referring to ethnicity as if it were a causal factor.

HEALTH INFLUENCES OF UNIQUE AND INTERSECTING IDENTITIES: AGE, SEXUAL ORIENTATION AND RACE

Abstract Lesbian, gay, and bisexual older adults are an understudied group with limited research using nationally representative samples. Although there are known physical health disparities based on age, sexual orientation, and race, the effects of intersecting identities have not been fully examined. We were interested in how these identities individually influence health and whether they interact to effect physical health. Using the 2020 Behavioral Risk Factor Surveillance System (M age = 54.30, SD = 17.52), we examined whether sexual orientation was related to the number of poor physical health days experienced and whether that relation was moderated by age and race. The overall model was significant (F (5, 223356) = 511.86, p < .001, R2 = .0113). Significant direct effects of sexual orientation and race emerged, but these were qualified by a significant sexual orientation by race interaction (b = -.09) A significant main effect emerged for age (b = 1.08) but the sexual orientation by age interaction failed to reach significance. There was a significant three-way interaction between age, race, and sexual orientation (F (2, 223356) = 6.34, p < .01). Investigation into the means found that multiracial adults tend to report more poor health days than White, Black, or Hispanic adults, except for bisexual older and younger adults. These results highlight the importance of examining intersecting identities when trying to understand health disparities across the lifespan. Understanding how these identities interact helps to identify specific barriers these groups face and ultimately improve health equity, specifically in an aging population.

Characterization of sleep among deaf individuals

ObjectivesNumerous health disparities are documented in deaf population research, but few empirical sleep assessments exist for this under-served population, despite knowledge that sleep contributes to physical and mental health disparities. We sought to document subjective and objective sleep in deaf adults with cross-sectional and prospective measures. MethodsTwenty deaf participants completed validated sleep and mental health questionnaires, 2-weeks of nightly sleep diaries and continuous wrist-worn actigraphy monitoring, and 1-week of nightly, reduced-montage EEG recordings. ResultsQuestionnaire data suggest high prevalence of insomnia (70%), poor sleep (75%), daytime sleepiness (25%) and nightmares (20%) among participants. Strong correlations were found between depression and sleep quality, fear of sleep, and insomnia severity (p’s < .005). Objective sleep assessments suggest elevated wake after sleep onset and low sleep efficiency and sleep duration. ConclusionsThe prevalence of sleep disturbance recorded from self-report and objective sleep measures provides preliminary evidence of sleep health disparity among deaf adults.

Addressing Chronic Stress and Opioid Use Disorder in Black Mothers with Small Children using Mindfulness-Based Stress Reduction: A Review

The opioid epidemic continues to be a growing public health concern in the United States, with Black mothers who have young children being a particularly vulnerable population. In this review, the authors first summarize the mental and physical health disparities faced by this population from the perspective of minority stress theory, considering the role of racial discrimination, gender stigma, trauma, parenting and other life stressors.

Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Health Education in Primary Care Graduate Medical Education Programs: A National Survey of Program Directors

Lesbian, gay, bisexual, transgender, queer, and other sexual and/or gender minority (LGBTQ+) people experience numerous health disparities. Graduate medical education (GME) programs need curricula to address these disparities. We sought to characterize curricula related to LGBTQ+ health in primary care specialty (internal medicine, combined internal medicine/pediatrics, family medicine, pediatrics, and geriatric medicine) GME, and to identify barriers experienced by program directors (PDs) in incorporating LGBTQ+ curriculum. We conducted a national survey study of PDs in August–October 2020 via Qualtrics. Overall, 292 of 1,571 eligible PDs responded (18.6%). Nearly a third of PDs (n= 96%; 32.9%) indicated that their program did not include any didactic training about LGBTQ+ health. Those who did indicated a mean of 5.4–5.7 hours in each year from PGY1-3 dedicated to LGBTQ+ health. Didactic and clinical training about LGBTQ+ health was overwhelmingly focused on content related to sexual health. PDs who indicated they had ‘out’ faculty were more likely to include didactic and clinical training on multiple aspects of LGBTQ+ health. Our results identify a significant gap and a need for the integration of LGBTQ+ content into primary care GME curricula with additional focus placed on domains associated with known mental and physical health disparities, beyond sexual health, and inclusion of transgender and gender diverse health needs. Programs may aim to accomplish this through recruitment of LGBTQ+ health educators, invitations to content experts in the field, and adaptation of existing resources to teach about LGBTQ+ health.

Rural Children's Well-Being in the Context of the COVID-19 Pandemic: Perspectives from Children in the Midwestern United States.

Children in rural areas are more likely to experience a variety of risk factors that increase their vulnerability to physical and mental health disparities. Bronfenbrenner's ecological model (1986) was used as a framework for understanding rural children's perceptions and well-being within multiple interactive contexts during the COVID-19 pandemic. This phenomenological study was designed to explore rural children's perceptions of their well-being and the impact of the COVID-19 pandemic on their contexts and well-being. This sub-study of the Children's Understandings of Well-Being project followed the standard qualitative interview protocol with additional prompts related to the pandemic. Rural children (age 8 to 18, N = 72) from the Midwestern United States participated from March 2020 to November 2021 via teleconferencing. Phenomenological analyses of transcripts focused on the essence of children's understanding of well-being and their perception of the impact of the pandemic on their contexts and well-being. Each transcript was coded by author 1 and verified by author 2, and discrepancies were identified, discussed, and resolved. The third author served as an external auditor to enhance trustworthiness. First-cycle coding focused on children's specific references to well-being experiences during COVID-19. Second-cycle selective coding focused on specific well-being experiences and contexts that were impacted by COVID-19. These codes were used to develop two broad themes, "Well This Kinda Stinks, But We Just Adapt" and "Safety Means Something Different to Me Now." The meaning of themes and subthemes are explored, with implications for researchers, practitioners, and policymakers.

Sex differences in epigenetic age in Mediterranean high longevity regions.

Sex differences in aging manifest in disparities in disease prevalence, physical health, and lifespan, where women tend to have greater longevity relative to men. However, in the Mediterranean Blue Zones of Sardinia (Italy) and Ikaria (Greece) are regions of centenarian abundance, male-female centenarian ratios are approximately one, diverging from the typical trend and making these useful regions in which to study sex differences of the oldest old. Additionally, these regions can be investigated as examples of healthy aging relative to other populations. DNA methylation (DNAm)-based predictors have been developed to assess various health biomarkers, including biological age, Pace of Aging, serum interleukin-6 (IL-6), and telomere length. Epigenetic clocks are biological age predictors whose deviation from chronological age has been indicative of relative health differences between individuals, making these useful tools for interrogating these differences in aging. We assessed sex differences between the Horvath, Hannum, GrimAge, PhenoAge, Skin and Blood, and Pace of Aging predictors from individuals in two Mediterranean Blue Zones and found that men displayed positive epigenetic age acceleration (EAA) compared to women according to all clocks, with significantly greater rates according to GrimAge (β = 3.55; p = 1.22 × 10-12), Horvath (β = 1.07; p = 0.00378) and the Pace of Aging (β = 0.0344; p = 1.77 × 10-08). Other DNAm-based biomarkers findings indicated that men had lower DNAm-predicted serum IL-6 scores (β = -0.00301, p = 2.84 × 10-12), while women displayed higher DNAm-predicted proportions of regulatory T cells than men from the Blue Zone (p = 0.0150, 95% Confidence Interval [0.00131, 0.0117], Cohen's d = 0.517). All clocks showed better correlations with chronological age in women from the Blue Zones than men, but all clocks showed large mean absolute errors (MAE >30years) in both sexes, except for PhenoAge (MAE <5years). Thus, despite their equal survival to older ages in these Mediterranean Blue Zones, men in these regions remain biologically older by most measured DNAm-derived metrics than women, with the exception of the IL-6 score and proportion of regulatory T cells.

Comparing Psychotropic Medication Prescriptions for Inpatient Transgender and Cisgender Adolescents

Transgender and gender nonconforming (TGNC) adolescents, defined as individuals whose gender identity does not align with sex assigned at birth, are at higher risk for mental and physical health complications and disparities compared to cisgender adolescents.1 TGNC individuals report negative healthcare experiences which can lead to avoidance of further medical care. Examples include use of wrong pronouns (misgendering), not calling patients by their updated name (deadnaming), being treated as an investigation instead of as human (probing), provider-imposed barriers to care (gatekeeping), and stigmatizing stances such as feeling unwelcomed by the provider.2 Additionally, studies reveal higher rates of suicide behaviors in TGNC compared to cisgender adolescents.3

Eating disorder risk in rural US adolescents: What do we know and where do we go?

Adolescence is a vulnerable period for the development of eating disorders, but there are disparities in eating disorder risk among adolescents. One population that may be at increased risk but is vastly understudied, is adolescents residing in rural regions within the United States. Rural communities face many mental and physical health disparities; however, the literature on rural adolescent eating disorder risk is nearly nonexistent. In this paper we summarize the scant literature on disordered eating and eating disorder risk and prevalence among rural US adolescents. We also detail eating disorder risk factors that may have unique influence in this population, including socioeconomic status, food insecurity, healthcare access, body image, and weight stigma. Given the presence of numerous eating disorder risk factors, we speculate that rural adolescents may be a particularly vulnerable population for eating disorders and we propose critical next steps in research for understanding eating disorder risk among the understudied population of rural adolescents. PUBLIC SIGNIFICANCE: Rural adolescents may be at increased risk for eating disorders due to disproportionate burden of known risk factors, though this relationship remains understudied. We present a summary of the literature on prevalence and unique risk factors, proposing that this may be a high-risk population. We detail next steps for research to understand eating disorder risk in this population to inform future prevention, identification, and treatment efforts needed in this community.

Mental and Physical Health Disparities Among Sexual and Gender Minority Adolescents Based on Disability Status.

Purpose: Sexual and gender minority (SGM) youth and youth with disabilities both experience health disparities. Little data exist on whether SGM youth with disabilities have worse health outcomes compared with SGM youth without disabilities. This study aimed to examine differences in health behaviors and outcomes among a sample of SGM youth by different types of disabilities. Methods: Secondary analyses were conducted with a subset (N = 9418) of the LGBTQ National Teen Survey, a comprehensive survey of risk and protective factors and health outcomes of SGM youth across the United States collected in 2017. Multiple types of disabilities (physical, cognitive, or psychiatric) and mental, behavioral, and physical health outcomes were self-reported. Results: Of the sample, 18.3% reported a disability. Significant findings included higher odds of exercise avoidance, greater depressive symptoms and sleep concerns, and lower self-esteem and overall health ratings among SGM youth who reported any form of disability compared with SGM youth who reported no disability. Youth with cognitive disabilities had lower odds of alcohol use than youth with no disability. Youth with psychiatric disabilities had higher odds of cannabis and cigarette use, and lower physical activity than youth with no disability. Youth with either psychiatric or physical disabilities reported higher body mass index than youth with no disability. Conclusion: SGM youth with disabilities experience greater health disparities than SGM youth with no reported disabilities. Results provide groundwork evidence about the impact of disability status on SGM adolescents. Disability-inclusive or -specific frameworks are needed for future interventions and studies of SGM youth.

Advancing global health and the sustainable development goals through transdisciplinary research and equitable publication practices

Advancing global health and the sustainable development goals through transdisciplinary research and equitable publication practices

Comparison of Transgender and Gender Diverse Demographics in United States Transgender Survey and the Behavioral Risk Factor Surveillance System

Transgender and Gender Diverse (TGD) individuals experience mental and physical health disparities but remain a difficult population to research. TGD scholars encounter barriers to accessing representative probability-based data to investigate prevalence of health issues experienced by TGD individuals. As population-based surveys begin to ask gender identity questions that identify TGD respondents, questions remain regarding representativeness of the actual TGD population. Community-based surveys continue to be the primary way to capture TGD-specific experiences and stressors, but without knowing true prevalence rates, there are challenges in interpreting generalizability. The present research compares demographics and health characteristics found in Behavioral Risk Factor Surveillance System (BRFSS) data from 2015 to 2018 and 2015 United States Transgender Survey (USTS) data, two commonly used probability and community-based datasets. As expected, BRFSS respondents were less likely to see a physician in the last year or be tested for HIV than USTS respondents. USTS respondents were less likely to identify as straight/heterosexual and more likely to report heavy drinking. While representative data of the TGD population continues to be a barrier, comparing characteristics across samples may help contextualize sample limitations.