Effects of Race and Gender Classifications on Atherosclerotic Cardiovascular Disease Risk Estimates for Clinical Decision-Making in a Cohort of Black Transgender Women

Tonia Poteat; Elle Lett; Ashleigh J Rich; Huijun Jiang; Andrea L Wirtz; Asa Radix; Sari L Reisner; Alexander B Harris; Jowanna Malone; William G La Cava; Catherine R Lesko; Kenneth H Mayer; Carl G Streed Jr

doi:10.1089/heq.2023.0066

Effects of Race and Gender Classifications on Atherosclerotic Cardiovascular Disease Risk Estimates for Clinical Decision-Making in a Cohort of Black Transgender Women

Health Equity. 2023 Nov 30;7(1):803-808. doi: 10.1089/heq.2023.0066. eCollection 2023.

Authors

Tonia Poteat¹, Elle Lett^{2

3

4}, Ashleigh J Rich¹, Huijun Jiang⁵, Andrea L Wirtz⁶, Asa Radix⁷, Sari L Reisner^{8

9

10

11}, Alexander B Harris⁷, Jowanna Malone¹², William G La Cava^{2

13}, Catherine R Lesko⁶, Kenneth H Mayer^{9

11

14}, Carl G Streed Jr^{11

15

16}

Affiliations

¹ Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
² Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA.
³ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Center for Applied Transgender Studies, Chicago, Illinois, USA.
⁵ Department of Biostatistics, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
⁶ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁷ Callen Lorde Community Health Center, New York, New York, USA.
⁸ Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham Women's Hospital, Boston, Massachusetts, USA.
⁹ Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
¹⁰ Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
¹¹ The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.
¹² Whitman Walker Institute, Washington, District of Columbia, USA.
¹³ Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
¹⁴ Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
¹⁵ Section of General Internal, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA.
¹⁶ GenderCare Center, Boston Medical Center, Boston, Massachusetts, USA.

Abstract

Introduction: Despite their dynamic, socially constructed, and imprecise nature, both race and gender are included in common risk calculators used for clinical decision-making about statin therapy for atherosclerotic cardiovascular disease (ASCVD) prevention.

Methods and materials: We assessed the effect of manipulating six different race-gender categories on ASCVD risk scores among 90 Black transgender women.

Results: Risk scores varied by operationalization of race and gender and affected the proportion for whom statins were recommended.

Discussion: Race and gender are social constructs underpinning racialized and gendered health inequities. Their rote use in ASCVD risk calculators may reinforce and perpetuate existing inequities.

Keywords: African American; cardiovascular risk calculator; statin; transgender.