OBJECTIVES: This study evaluates intersectional differences in risk of myocardial infarction (MI) among transgender compared to same-race/ethnicity cisgender adults.

METHODS: This was a retrospective study utilizing the U.S. Centers for Disease Control and Prevention BRFSS survey data from 2017-2022. Gender identity was self-reported and classified as transgender woman, transgender man, cisgender woman, or cisgender man. Prior MI was self-reported and classified using binary responses (Yes/No). Logistic regression models for MI were used to assess risks across genders and racial/ethnic groups (White; Black/African American; American Indian/Alaskan Native (AI/AN); Asian; Native Hawaiian or other Pacific Islander (NH/PI); multiracial/other race (Other); and Hispanic). Covariates included sociodemographic factors, health status indicators, and health behaviors. Complex sampling procedures were applied to all analyses.

RESULTS: 137,563,328 adults were included (599,840 transgender adults and 136,963,488 cisgender adults). Among transgender adults, trends in reported MI decreased from its peak (10.5%) in 2017 to 4.4% in 2022. Both transgender women (aOR, 1.547; 95% CI, 1.046-2.287) and transgender men (aOR, 1.973; 95% CI, 1.273-3.06) demonstrated higher odds of MI compared to cisgender females; transgender adults vs. cisgender males showed no significant differences. Hispanic, AI/AN, and Black transgender adults exhibited 2.81x, 1.66x, and 1.35x higher rates of MI compared with cisgender adults within the same race/ethnic groups. Transgender AI/AN men were more likely to report MI vs. cisgender AI/AN women (aOR 8.244; 95% CI 2.66-25.552) and AI/AN men (aOR 4.542; 95% CI, 1.21-17.056). Hispanic transgender vs. cisgender women demonstrated higher odds of reporting MI (aOR 2.807; 95% CI 1.342-5.868). Notably, transgender AS/NH/PI women demonstrated significantly lower odds of reported MI compared to cisgender women and men.

CONCLUSIONS: Despite a significant decrease in MI within the transgender population, disparities persist by various magnitudes between different racial/ethnic groups, revealing a complex interplay of biological and sociodemographic factors that influence risk of MI in this population.