Structural drivers of health among transgender women in the United States: A nationwide study

Abstract

Introduction

Residential segregation and gentrification are associated with a variety of health outcomes. However, few studies in this area have included transgender women, who experience well-documented health inequities. This analysis sought to assess the effects of racialized economic segregation and gentrification on psychological distress and self-rated health (SRH).

Methods

398 transgender women in the United States completed a baseline survey between June 14, 2021 and May 1, 2022 and a follow-up survey 12 months later. Neighborhood-level racialized economic advantage and gentrification were measured at the ZIP code level and categorized into tertiles. The first tertile reflected the lowest levels of these measures. Multilevel modified Poisson regression models with individual-level random intercepts and robust variance estimation, were used to estimate unadjusted and adjusted associations of racialized economic residential advantage and gentrification with serious psychological distress (Kessler-6 ≥ 13) and SRH (poor/fair vs good/very good/excellent).

Results

Ethnoracial identities included 57 % White, 19 % Black, and 9 % Latine (of any race). The highest tertile of racialized economic advantage (vs the lowest) was associated with increased risk of serious psychological distress (RR = 1.28; 95 %CI = 1.02, 1.61) and higher risk of poor-to-fair SRH (RR = 1.51; 95 % CI = 1.10,2.08) in multivariable models, while gentrification showed no significant association with either outcome.

Discussion

These findings are consistent with prior research indicating that minoritized populations may not derive health benefits from residing in more socially and economically advantaged neighborhoods. Future research is needed to better understand the experiences of transgender women who may be exposed to transphobia in both advantaged and disadvantaged neighborhoods.