Physical and Mental Disabilities among the Gender-Diverse Population Using the Behavioral Risk Factor Surveillance System, BRFSS (2017-2019): A Propensity-Matched Analysis

This propensity-matched analysis utilized the publicly available Behavioral Risk Factor Surveillance System (2017-2019) data to compare the burden of disabilities among transgender/non-binary (TGNB) and cisgender groups. The groups were matched (1:1 ratio) on demographic variables using Nearest Neighborhood Matching. Categorical variables were compared among groups using a Chi-square analysis to test differences in the proportions. Multivariate logistic regression analysis was fit to predict the likelihood of the physical and mental disabilities among the TGNB group compared with the cisgender group while controlling for healthcare access factors, income, and employment. Survey weights were included in the model to account for the complex survey design. In a weighted sample of 664,103 respondents, only 2827 (0.4%) self-identified as TGNB. In the matched sample, a higher proportion of the TGNB group belonged to the low-income group (39.5% vs. 29.8%, p < 0.001), were unable to work (12.5% vs. 8.6%, p < 0.001), and delayed care due to cost barriers (19.0% vs. 12.4%, p < 0.001). Compared with the cisgender group, the odds of having difficulty making decisions were 1.94 times higher (95% CI: 1.67-2.27) and odds of difficulty walking were 1.38 times higher (95% CI: 1.19, 1.59) among the TGNB group. Additionally, the TGNB group had 59.8% higher adjusted odds ratio (aOR) (aOR 1.598, 95% Confidence interval (CI): 1.256, 2.034) of experiencing difficulty dressing and 83.3% higher odds (aOR 1.833, 95% CI: 1.533, 2.191) in having difficulty doing things alone. The findings of this study advocate for developing policies and interventions to deliver culturally competent care to the TGNB population with disabilities.