Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.
Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA.
Med Care. 2021 Feb 1;59:S31-S35. doi: 10.1097/MLR.0000000000001384.
Limited research suggests that rates of suicide death among transgender people may be higher than their nontransgender peers.
The objective of this study was to compare rates of suicide deaths by different means between transgender and nontransgender patients.
This secondary analysis used VHA administrative and electronic health record (EHR) data from October 1, 1999 through December 31, 2016.
Transgender patients (n=8981) were categorized as such based on a set of International Classification of Disease codes, and a comparison sample was selected by randomly choosing 3 nontransgender patients (n=26,924).
Cause and date of death data are from the National Death Index. Because of low frequencies amid different methods of suicide death, we combined categories into self-poisoning; hanging, strangulation and suffocation; discharge of firearms; and self-harm by all other and unspecified means. We conducted Cox regression analyses to model time-to-event for each method of suicide, adjusted for age, sex based on EHR, race, ethnicity, marital status, and whether patients had ever been diagnosed with depression.
Among transgender patients, 73 died by suicide (22 female EHR-based sex, 51 male EHR-based sex), and among nontransgender patients, 71 died by suicide (4 female EHR-based sex, 67 male EHR-based sex). In adjusted models, transgender patients had significantly greater hazards of death by self-poisoning and firearms than their nontransgender peers.
Differences in methods of suicide death suggest that firearms and self-poisoning may be specific areas of concern for transgender individuals experiencing suicidal crisis, which underscore needs for examining effective delivery of evidence-based care.
有限的研究表明，跨性别者的自杀死亡率可能高于非跨性别者。
本研究旨在比较跨性别和非跨性别患者不同方式自杀死亡的比率。
这项二次分析使用了从 1999 年 10 月 1 日至 2016 年 12 月 31 日退伍军人事务部的行政和电子健康记录（EHR）数据。
根据一套国际疾病分类代码，将跨性别者患者（n=8981）分为此类，然后通过随机选择 3 名非跨性别者患者（n=26924）选择了一个比较样本。
死因和死亡日期数据来自国家死亡索引。由于不同自杀方式的频率较低，我们将类别合并为自毒、上吊、绞杀和窒息、枪支射出和其他所有和未指定方式的自我伤害。我们进行了 Cox 回归分析，以对每种自杀方式的时间事件进行建模，调整了年龄、基于 EHR 的性别（女性 22 例，男性 51 例）、种族、民族、婚姻状况以及患者是否曾被诊断为抑郁症。
在跨性别者患者中，有 73 人自杀身亡（22 例基于 EHR 的女性性别，51 例基于 EHR 的男性性别），而非跨性别者患者中，有 71 人自杀身亡（4 例基于 EHR 的女性性别，67 例基于 EHR 的男性性别）。在调整后的模型中，跨性别者患者自杀的自我中毒和枪支风险明显更高。
自杀死亡方式的差异表明，枪支和自我中毒可能是跨性别个体自杀危机的特定关注领域，这突显了需要检查提供循证护理的有效性。
