Measuring Transgender Health Disparities: The Impact of Gender-Inclusive Legislation on Health Status, Behaviors, and Healthcare Access

The transgender community experiences pervasive social, political, and economic marginalization which shapes physical and mental health trajectories. Structural barriers to LGBTQ+ competent health services further exacerbate disparities in health outcomes and behaviors. This study analyzes data from the CDC’s Behavioral Risk Factor Surveillance System (2020–2022) to assess national disparities in health status, risk behaviors, and healthcare access between transgender and cisgender adults. To investigate the influence of state-level inclusivity on transgender health, state-specific legislative protections of gender identity and the State Equality Index developed by the Human Rights Campaign are incorporated. Findings indicate that transgender respondents are significantly more likely than their cisgender counterparts to report mental health challenges and are less likely to afford and utilize routine healthcare or other necessary services. Poor self-rated general health, frequent physical distress, engagement with risk behaviors (smoking and never exercising), and inability to access healthcare are amplified for transgender people living in states classified as restrictive of the LGBTQ+ community. State-level protections in housing, public accommodations, and education, as well as bans on gender-based health insurance exclusions, are most strongly associated with reduced negative health outcomes and behaviors among transgender respondents. These findings highlight the critical role of inclusive state policies in mitigating health disparities and promoting well-being within the transgender community.