Key points Do transgender people have higher rates of suicide attempts and mortality than non-transgender people? Findings In this nationwide cohort study of 6,657,456 people born in Denmark, transgender people identified through hospital and administrative records had significantly higher rates of attempted suicide (adjusted incidence rate ratio [aIRR], 7.7). , suicide mortality (aIRR, 3.5), non-suicide mortality (aIRR, 1.9), and all-cause mortality (aIRR, 2.0) compared to non-transgender people. Meaning This Danish population-based cohort study spanning over 4 decades found that transgender people had higher rates of suicide attempts and mortality compared to non-transgender people. |
Importance
Previous studies have suggested that transgender people may be a high-risk group with respect to suicide attempt and mortality, but large-scale population-based research is lacking.
Aim
To examine in a national setting whether transgender people have higher rates of suicide attempts and mortality than non-transgender people.
Design, environment and participants
Nationwide, retrospective, registry-based cohort study of all 6,657,456 Danish-born people aged 15 years or older who lived in Denmark between January 1, 1980 and December 31, 2021.
Exposure
Transgender identity was determined through national hospital records and administrative legal gender reassignment records.
Main results and measures
Suicide attempts, suicide deaths, non-suicidal deaths, and deaths from any cause were identified between 1980 and 2021 in national hospitalization and cause of death registries. Adjusted incidence rate ratios (aIRRs) with 95% CIs were calculated controlling for calendar period, sex assigned at birth, and age.
Results
The 6,657,456 study participants (50.0% assigned male at birth) were followed for 171,023,873 person-years. Overall, 3,759 people (0.06%; 52.5% assigned male at birth) were identified as transgender at a median age of 22 years (IQR, 18-31 years) and followed for 21,404 years. -person, during which 92 suicide attempts were detected, 12 suicides and 245 non-suicide related deaths occurred.
Standardized rates of suicide attempts per 100,000 person-years were 498 for transgender people versus 71 for nontransgender people (aIRR, 7.7; 95% CI, 5.9-10.2).
Standardized suicide mortality rates per 100,000 person-years were 75 for transgender people versus 21 for nontransgender people (aIRR, 3.5; 95% CI, 2.0-6.3).
Standardized nonsuicide mortality rates per 100,000 person-years were 2380 for transgender people versus 1310 for nontransgender people (aIRR, 1.9; 95% CI, 1.6-2.2), and Standardized all-cause mortality rates per 100,000 person-years were 2559 for transgender people versus 1331 for nontransgender people (aIRR, 2.0; 95% CI, 1.7-2.4).
Despite decreasing rates of suicide attempts and mortality over the 42 years covered, aIRRs remained significantly elevated in recent calendar periods up to and including 2021 for suicide attempts (aIRR, 6.6; 95% CI, 4.5 -9.5), suicide mortality (aIRR, 2.8; 95% CI, 1.3-5.9), non-suicide mortality (aIRR, 1.7; 95% CI, 1. 5-2.1) and all-cause mortality (aIRR, 1.7; 95% CI, 1.4-2.1).
Conclusions and relevance In this Danish population-based retrospective cohort study, results suggest that transgender people had significantly higher rates of suicide attempt, suicide mortality, non-suicide mortality, and all-cause mortality compared to the population. not transgender. |
