Department of Biomedical Informatics & Data Science, Yale School of Medicine, New Haven, CT, United States.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States.
J Affect Disord. 2024 Dec 1;366:364-369. doi: 10.1016/j.jad.2024.08.174. Epub 2024 Aug 27.
Transgender and gender diverse (TGD) individuals have elevated mental and physical health disparities and a greater mortality risk compared to their cisgender (non-TGD) counterparts.
We assessed differences in the association of depression with all-cause and cardiovascular disease (CVD) mortality among TGD and cisgender Veterans Administration patients. A sample of 8981 TGD patients, matched 1:3 with cisgender patients (n = 26,924) patients, was created from administrative and electronic health record data from October 1, 1999 to December 31, 2016. Cox proportional regression models stratified by gender modality (i.e., TGD and cisgender) were used to assess the hazard of all-cause and CVD mortality associated with a history of depression.
Adjusted models demonstrated that depression was significantly associated with a greater hazard of all-cause mortality among both TGD (aHR:1.18, 95 % CI: 1.04-1.34) and cisgender (aHR:1.22, 95 % CI: 1.17-1.28) patients. Similar to all-cause mortality, depression was significantly associated with a greater hazard of CVD mortality among cisgender patients ≥65 years (aHR = 1.23, 95 % CI = 1.13-1.35). Findings for TGD patients showed a similar pattern, though results were not significant.
Hazards may be underestimated since depression may be underdiagnosed. Further, we were unable to adjust for other health-related risk factors tied to mortality (e.g., smoking).
Overall, depression was associated with a greater hazard of all-cause mortality among both TGD and cisgender patients. Future work should assess the equity of reach, quality, and outcomes of treatment for depression for TGD populations given the lack of attention to addressing the needs of this important patient demographic.
与顺性别（非跨性别）个体相比，跨性别和性别多样化（跨性别）个体的精神和身体健康差距更大，死亡率更高。
我们评估了抑郁与跨性别和顺性别退伍军人管理局患者全因和心血管疾病（CVD）死亡率之间关联的差异。从 1999 年 10 月 1 日至 2016 年 12 月 31 日的行政和电子健康记录数据中创建了一个由 8981 名跨性别患者组成的样本，与 3 名顺性别患者匹配（n=26924）。使用按性别模式（即跨性别和顺性别）分层的 Cox 比例风险回归模型评估了抑郁病史与全因和 CVD 死亡率相关的风险比。
调整模型表明，抑郁与跨性别（aHR：1.18，95%CI：1.04-1.34）和顺性别（aHR：1.22，95%CI：1.17-1.28）患者全因死亡率的风险比显著相关。与全因死亡率相似，抑郁与≥65 岁的顺性别患者 CVD 死亡率的风险比显著相关（aHR=1.23，95%CI=1.13-1.35）。跨性别患者的结果也呈现出类似的模式，尽管结果不显著。
由于抑郁可能诊断不足，因此危险可能被低估。此外，我们无法调整与死亡率相关的其他健康相关风险因素（例如，吸烟）。
总的来说，抑郁与跨性别和顺性别患者的全因死亡率风险比显著相关。鉴于缺乏关注解决这一重要患者群体的需求，未来的工作应该评估针对跨性别人群的抑郁治疗的可及性、质量和治疗效果的公平性。
