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Primary Submission Category: LGBTQ+
Impacts of systematic exclusions based on respondent gender, Washington State BRFSS, 2023-2025
Authors: Graham Crawbuck, Rachelle Martin, Brynn Stopczynski, Jessica Marcinkevage, Maayan Simckes,
Presenting Author: Graham Crawbuck*
BACKGROUND:
The Behavioral Risk Factor Surveillance System (BRFSS) is a health survey coordinated by the Centers for Disease Control and Prevention (CDC) and administered by the Washington State Department of Health (DOH). Individuals 18 or older who live in a private residence are eligible to participate. Prior to 2021, the survey excluded all individuals who do not self-describe as either male or female; CDC required states to return to this practice in 2025. During the 2023 and 2024 surveys, the BRFSS ascertained both gender identity (GI) and sex assigned at birth (SAAB) on the screener and included some respondents who did not identify with a binary gender.
METHODS:
To evaluate the impact of gender-based exclusions on survey representativeness over time, DOH analyzed data from two sources. First, we looked at the Washington BRFSS from 2023 through 2025. We identified individuals excluded during the screener and estimated the proportion of included survey respondents who reported a nonbinary GI. Second, we analyzed US Census Bureau Pulse Survey data to identify the proportion of US residents who identify with nonbinary genders.
RESULTS:
Of the 33,386 participants who began the 2023 BRFSS screener, 162 (0.5%) were excluded because of their GI and SAAB. A similar proportion was excluded in 2024, and in 2025, 208 out of 25,571 (0.8%) were excluded. Ninety-seven participants identified with a nonbinary GI in 2023 (weighted prevalence = 0.6%), and 119 did in 2024 (weighted prevalence = 0.8%). Findings from the Census Pulse Survey estimate that 1.7% of the nation self-identifies with a nonbinary GI.
CONCLUSION:
Findings indicate that many Washingtonians were excluded from participating in BRFSS based on their GI and SAAB and that Washington’s survey sample is less diverse than the nation. By changing the survey to allow nonbinary responses to the GI and SAAB screener question, Washington would mitigate selection bias and increase the survey’s representativeness.