Prevalence and Incidence of Heart Failure Phenotypes Among Transgender and Gender‐Diverse Adults in the United States

BACKGROUND: Prevalent and incident heart failure (HF) and its comorbidities have not been characterized in transgender and gender-diverse (TGD) populations. This study determines the prevalence and incidence of HF phenotypes by gender identity. METHODS: A retrospective cohort analysis was performed using deidentified administrative claims from the Optum Labs Data Warehouse (2006-2022). TGD adults and a sample of demographically similar cisgender comparators were identified using a validated algorithm, and gender identity was categorized as cisgender man, cisgender woman, transmasculine, transfeminine, or unclassified TGD. Prevalent and incident HF, including systolic, diastolic, and unclassified phenotypes, were assessed using diagnosis codes. Multivariable logistic and Cox regression models adjusted for age and comorbidities evaluated associations between gender identity and HF. RESULTS: In this cohort of 57 471 TGD individuals and 298 213 demographically similar cisgender comparators, 17 898 TGD people (31.1%) were transmasculine, 9652 (16.8%) were transfeminine, and 29 921 (52.1%) had unclassified TGD identity. In adjusted models, transmasculine people experienced less prevalent systolic HF than cisgender men (odds ratio, 0.37 [98.75% CI, 0.17-0.83]) and women (odds ratio, 0.42 [98.75% CI, 0.19-0.92]). Transmasculine people experienced less incident diastolic HF relative to cisgender men (hazard ratio [HR], 0.65 [98.75% CI, 0.51-0.82]) and women (HR, 0.66 [98.75% CI, 0.52-0.83]). Transfeminine people experienced more incident diastolic HF than cisgender men (HR, 1.36 [98.75% CI, 1.05-1.77]) and women (HR, 1.38 [98.75% CI, 1.07-1.79]). CONCLUSIONS: Prevalent systolic HF and incident diastolic HF differed by gender identity after adjustment for age and clinical comorbidities. Further research is needed to identify underrecognized sex- and gender-based HF risk modifiers.