Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
Department of Medical Education, Brighton & Sussex Medical School, Brighton, United Kingdom.
JAMA Netw Open. 2023 Jan 3;6(1):e2253687. doi: 10.1001/jamanetworkopen.2022.53687.
Limited prior research suggests that transgender and gender diverse (TGD) people may have higher mortality rates than cisgender people.
To estimate overall and cause-specific mortality among TGD persons compared with cisgender persons.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used data from general practices in England contributing to the UK's Clinical Practice Research Datalink GOLD and Aurum databases. Transfeminine (assigned male at birth) and transmasculine (assigned female at birth) individuals were identified using diagnosis codes for gender incongruence, between 1988 and 2019, and were matched to cisgender men and women according to birth year, practice, and practice registration date and linked to the Office of National Statistics death registration. Data analysis was performed from February to June 2022.
Cause-specific mortality counts were calculated for categories of disease as defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision chapters. Overall and cause-specific mortality rate ratios (MRRs) were estimated using Poisson models, adjusted for index age, index year, race and ethnicity, Index of Multiple Deprivation, smoking status, alcohol use, and body mass index.
A total of 1951 transfeminine (mean [SE] age, 36.90 [0.34] years; 1801 White [92.3%]) and 1364 transmasculine (mean [SE] age, 29.20 [0.36] years; 1235 White [90.4%]) individuals were matched with 68 165 cisgender men (mean [SE] age, 33.60 [0.05] years; 59 136 White [86.8%]) and 68 004 cisgender women (mean [SE] age, 33.50 [0.05] years; 57 762 White [84.9%]). The mortality rate was 528.11 deaths per 100 000 person-years (102 deaths) for transfeminine persons, 325.86 deaths per 100 000 person-years (34 deaths) for transmasculine persons, 315.32 deaths per 100 000 person-years (1951 deaths) for cisgender men, and 260.61 deaths per 100 000 person-years (1608 deaths) for cisgender women. Transfeminine persons had a higher overall mortality risk compared with cisgender men (MRR, 1.34; 95% CI, 1.06-1.68) and cisgender women (MRR, 1.60; 95% CI, 1.27-2.01). For transmasculine persons, the overall MMR was 1.43 (95% CI, 0.87-2.33) compared with cisgender men and was 1.75 (95% CI, 1.08-2.83) compared with cisgender women. Transfeminine individuals had lower cancer mortality than cisgender women (MRR, 0.52; 95% CI, 0.32-0.83) but an increased risk of external causes of death (MRR, 1.92; 95% CI, 1.05-3.50). Transmasculine persons had higher mortality from external causes of death than cisgender women (MRR, 2.77; 95% CI, 1.15-6.65). Compared with cisgender men, neither transfeminine nor transmasculine adults had a significantly increased risk of deaths due to external causes.
In this cohort study of primary care data, TGD persons had elevated mortality rates compared with cisgender persons, particularly for deaths due to external causes. Further research is needed to examine how minority stress may be contributing to deaths among TGD individuals to reduce mortality.
有限的先前研究表明，跨性别和性别多样化（TGD）人群的死亡率可能高于顺性别人群。
估计 TGD 人群与顺性别人群相比的总体和特定原因死亡率。
设计、设置和参与者：这项基于人群的队列研究使用了来自英国临床实践研究数据链接 GOLD 和 Aurum 数据库的一般实践的数据。在 1988 年至 2019 年期间，使用性别不一致的诊断代码识别出易性症（出生时被指定为男性）和跨性别男性（出生时被指定为女性）个体，并根据出生年份、实践和实践注册日期与顺性别男性和女性相匹配，并与国家统计局的死亡登记处相关联。数据分析于 2022 年 2 月至 6 月进行。
根据国际疾病分类和相关健康问题第十版章节，为疾病类别计算了特定原因的死亡率计数。使用泊松模型估计总体和特定原因死亡率比率（MRR），并根据指数年龄、指数年份、种族和民族、多重剥夺指数、吸烟状况、饮酒状况和体重指数进行调整。
共匹配了 1951 名易性症（平均[SE]年龄，36.90[0.34]岁；1801 名白人[92.3%]）和 1364 名跨性别男性（平均[SE]年龄，29.20[0.36]岁；1235 名白人[90.4%]）与 68005 名顺性别男性（平均[SE]年龄，33.60[0.05]岁；59006 名白人[86.8%]）和 68004 名顺性别女性（平均[SE]年龄，33.50[0.05]岁；57002 名白人[84.9%]）。易性症人群的死亡率为每 100000 人年 528.11 人死亡（102 人死亡），跨性别男性的死亡率为每 100000 人年 325.86 人死亡（34 人死亡），顺性别男性的死亡率为每 100000 人年 315.32 人死亡（1951 人死亡），顺性别女性的死亡率为每 100000 人年 260.61 人死亡（1608 人死亡）。与顺性别男性（MRR，1.34；95%CI，1.06-1.68）和顺性别女性（MRR，1.60；95%CI，1.27-2.01）相比，易性症人群的整体死亡率风险更高。对于跨性别男性，总体 MMR 为 1.43（95%CI，0.87-2.33），与顺性别男性相比，与顺性别女性相比为 1.75（95%CI，1.08-2.83）。易性症个体的癌症死亡率低于顺性别女性（MRR，0.52；95%CI，0.32-0.83），但外部原因死亡的风险增加（MRR，1.92；95%CI，1.05-3.50）。跨性别男性的外部原因死亡死亡率高于顺性别女性（MRR，2.77；95%CI，1.15-6.65）。与顺性别男性相比，易性症和跨性别男性成年人死于外部原因的风险均无显著增加。
在这项初级保健数据的基于人群的队列研究中，TGD 人群的死亡率与顺性别人群相比有所升高，特别是由于外部原因导致的死亡。需要进一步研究少数群体压力如何导致 TGD 个体死亡，以降低死亡率。
