Sex and gender differences in risk scores for dementia and Alzheimer's disease among cisgender, transgender, and non‐binary adults

• Published in: Alzheimer's & dementia 2024-01, Vol.20 (1), p.5-15
• Main Authors: Brady, Brooke, Zheng, Lidan, Kootar, Scherazad, Anstey, Kaarin Jane
• Format: Article
• Language: English
• Subjects: Adult; Adults; Algorithms; Alzheimer Disease - epidemiology; Alzheimer's disease; Alzheimer's disease risk; Cardiovascular disease; Cisgender; Cohort analysis; Cohort Studies; Dementia; dementia risk; Education; Female; Females; gender; Gender differences; Gender Identity; Health risk assessment; Humans; Hypertension; Male; Males; Middle age; Non-binary gender; Polls & surveys; Protective factors; Risk behavior; Risk Factors; sex; sex and gender differences; Sex differences; Sex Factors; Surveillance systems; Transgender Persons; Womens health
• ISSN: 1552-5260; 1552-5279; 1552-5279
• DOI: 10.1002/alz.13317

INTRODUCTION Few studies have explored dementia risk according to sex and gender including for transgender and non‐binary adults. This study evaluated dementia risk factors and risk scores among cisgender, transgender, and non‐binary adults. METHODS Observational data were drawn from the 2019 Behavioral Risk Factor Surveillance System. A matched‐cohort approach was used to develop sex (male, female) and gender identity cohorts (cisgender men, cisgender women, transgender men, transgender women, and non‐binary adults) for comparison. Dementia risk scores were calculated using established mid‐life and late‐life risk score algorithms. RESULTS Males had higher overall mid‐life dementia risk, and lower late‐life Alzheimer's disease risk compared to females. Transgender men, transgender women, and non‐binary adults had higher overall late‐life risk compared to both cisgender men and women. DISCUSSION Future research is needed to build the evidence base for specific risk factors that may be contributing to higher overall risk among understudied and underserved gender groups. Highlights Using data from the 2019 Behavioral Risk Factor Surveillance System, this matched‐cohort study found that those assigned female at birth had lower overall mid‐life dementia risk and higher overall late‐life Alzheimer's disease (AD) risk compared to those assigned male at birth. Transgender men, transgender women, and non‐binary adults all showed higher overall late‐life AD risk compared to cisgender men and cisgender women. Between‐group differences were found in the incidence of specific risk and protective factors for dementia and AD.