State Policies and Health Disparities between Transgender and Cisgender Adults: Considerations and Challenges Using Population-Based Survey Data

Context: The authors examined the association between state-level policy protections and self -rated health disparities between transgender and cisgender adults.Methods: They used data on transgender (n=4,982) and cisgender (n=1,168,859) adults from the 2014-2019 Behavioral Risk Factor Surveillance System. The authors estimated state-specific health disparities between transgender and cisgender adults, and they used multivariable logistic regression models to compare adjusted odds ratios between transgender and cisgender adults by state-level policy environments.Findings: Transgender adults were significantly more likely to report poor/fair health, frequent mental distress, and frequent poor physical health days compared to cisgender adults. Disparities between transgender and cisgender adults were found in states with strengthened protections and in states with limited protections. Compared to transgender adults in states with limited pro-tections, transgender adults in states with strengthened protections were marginally less likely to report frequent mental distress.Conclusions: Transgender adults in most states reported worse self-rated health than their cis -gender peers. Much more research and robust data collection on gender identity are needed to study the associations between state policies and transgender health and to identify best practices for achieving health equity for transgender Americans.