Examining Cardiovascular Disease (CVD) History and Risk Factors Among Sexual and Gender Minority (SGM) Adults

Cardiovascular diseases (CVDs) are one of the leading causes of death both worldwide and in the U.S. Previous research has found that sexual and gender minority (SGM) adults exhibit high risk factors for CVD; however, there is a lack of research examining CVD history and related risk factors at the intersection of sexual orientation and gender identity (SOGI). This dissertation utilized a preprint/reprint format where each manuscript examined different research questions aimed to evaluate differences among adult SOGI subgroups in terms of CVD history, modifiable CVD risk factors, and social determinants of health (SDOH) measures using data from the 2018-2023 Behavioral Risk Factor Surveillance Survey (BRFSS). SOGI subgroups were created at the intersection of sexual orientation, either straight or sexual minority (SM), and gender identity, either transgender, cisgender, or gender nonconforming (GNC).

The first study found that transgender, GNC, and cisgender adults who are straight had lower odds of CVD histories (heart attack, coronary heart disease, stroke, and history of any CVD) when compared to SM respondents of the same gender identity, except for coronary heart disease among GNC adults. The second study found that transgender SM adults had higher odds of reporting physical activity compared to all other SOGI subgroups, except for GNC straight adults; moreover, GNC and cisgender SM adults had the highest odds of alcohol consumption, transgender and GNC straight adults had the highest odds of tobacco use, and GNC SM had the highest odds of poor mental health days of all SOGI subgroups. The third study found that transgender SM adults had the highest odds of dissatisfaction with life, mental stress, and lacking reliable transportation of all SOGI subgroups. Across all three studies, there were significant differences based on the intersection of SOGI, even after controlling for relevant demographic variables in multivariate analyses. These studies suggest that there may be a compounding effect on CVD history and risk factors related to the intersection of SOGI. Taken together, the findings from each study underscore the importance of SOGI data collection and intersectional analysis, highlight potential opportunities to mitigate disparities, and build rationale for additional investigations.