Suicide, Homicide, and All-Cause Mortality Among Transgender and Cisgender Patients in the Veterans Health Administration

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).