Taylor L Boyer1, Ada O Youk1,2, Ann P Haas3, George R Brown4,5, Jillian C Shipherd6,7,8, Michael R Kauth6,9,10, Guneet K Jasuja11,12, John R Blosnich1,13. 1. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA. 2. Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 3. Department of Health Sciences, Lehman College, City University of New York, Bronx, New York, USA. 4. Mountain Home VA Medical Center, Johnson City, Tennessee, USA. 5. Department of Psychiatry and Behavioral Sciences, East Tennessee State University, Johnson City, Tennessee, USA. 6. Lesbian, Gay, Bisexual, and Transgender Health Program, Office of Patient Care Services, Veterans Health Administration, Washington, District of Columbia, USA. 7. National Center for Post-traumatic Stress Disorder, VA Boston Healthcare System, Boston, Massachusetts, USA. 8. Boston University School of Medicine, Boston, Massachusetts, USA. 9. South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA. 10. Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA. 11. Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers VA Medical Center, Bedford, Massachusetts, USA. 12. Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA. 13. Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA.
Abstract
Purpose: This study examines the differences in suicide, homicide, and all-cause mortality between transgender and cisgender Veterans Health Administration (VHA) patients. Methods: VHA electronic medical record data from October 1, 1999 to December 31, 2016 were used to create a sample of transgender and cisgender patients (n = 32,441). Cox proportional hazard regression was used to evaluate differences in survival time (date of birth to death date/study end). Death data were from the National Death Index. Results: Transgender patients had more than twofold greater hazard of suicide than cisgender patients (adjusted hazard ratio [aHR] = 2.77, 95% confidence interval [CI] = 1.88-4.09), especially among younger (18-39 years) (aHR = 3.35, 95% CI = 1.30-8.60) and older (≥65 years) patients (aHR = 9.48, 95% CI = 3.88-23.19). Alternatively, transgender patients had an overall lower hazard of all-cause mortality (aHR = 0.90, 95% CI = 0.84-0.97) compared with cisgender patients, which was driven by patients 40-64 years old (aHR = 0.78, 95% CI = 0.72-0.86) and reversed by those 65 years and older (aHR = 1.17, 95% CI = 1.03-1.33). Conclusion: Transgender patients' hazard of suicide mortality was significantly greater than that of cisgender VHA patients.
Purpose: This study examines the differences in suicide, homicide, and all-cause mortality between transgender and cisgender Veterans Health Administration (VHA) patients. Methods: VHA electronic medical record data from October 1, 1999 to December 31, 2016 were used to create a sample of transgender and cisgender patients (n = 32,441). Cox proportional hazard regression was used to evaluate differences in survival time (date of birth to death date/study end). Death data were from the National Death Index. Results: Transgender patients had more than twofold greater hazard of suicide than cisgender patients (adjusted hazard ratio [aHR] = 2.77, 95% confidence interval [CI] = 1.88-4.09), especially among younger (18-39 years) (aHR = 3.35, 95% CI = 1.30-8.60) and older (≥65 years) patients (aHR = 9.48, 95% CI = 3.88-23.19). Alternatively, transgender patients had an overall lower hazard of all-cause mortality (aHR = 0.90, 95% CI = 0.84-0.97) compared with cisgender patients, which was driven by patients 40-64 years old (aHR = 0.78, 95% CI = 0.72-0.86) and reversed by those 65 years and older (aHR = 1.17, 95% CI = 1.03-1.33). Conclusion: Transgender patients' hazard of suicide mortality was significantly greater than that of cisgender VHA patients.
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