Parents faced with decisions about their minor children's thoughts ought to have full access to the known health consequences.

The Key Points, Abstract, and Introduction are excerpted here. Method and more detailed analysis are available at the link.

 

Transgender Identity and Suicide Attempts and Mortality in Denmark

Original Investigation By Annette Erlangsen, PhD; Anna Lund Jacobsen, BSc; Anne Ranning, PhD June 27, 2023

Key Points

Question  Do transgender individuals have higher rates of suicide attempt and mortality than nontransgender individuals?

Findings  In this nationwide cohort study of 6 657 456 Danish-born individuals, transgender individuals identified through hospital and administrative registers had significantly higher rates of suicide attempt (adjusted incidence rate ratio [aIRR], 7.7), suicide mortality (aIRR, 3.5), suicide-unrelated mortality (aIRR, 1.9), and all-cause mortality (aIRR, 2.0) compared with nontransgender individuals.

Meaning  This Danish population-based cohort study spanning more than 4 decades found that transgender individuals had higher rates of suicide attempt and mortality compared with nontransgender individuals.

Abstract

Importance  Prior studies have suggested that transgender individuals may be a high-risk group with respect to suicide attempt and mortality, but large-scale, population-based investigations are lacking.

Objective  To examine in a national setting whether transgender individuals have higher rates of suicide attempt and mortality than nontransgender individuals.

Design, Setting, and Participants  Nationwide, register-based, retrospective cohort study on all 6 657 456 Danish-born individuals 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 records of legal change of gender.

Main Outcomes and Measures  Suicide attempts, suicide deaths, nonsuicidal deaths, and deaths by any cause during 1980 through 2021 were identified in national hospitalization and causes of death registers. Adjusted incidence rate ratios (aIRRs) with 95% CIs controlling for calendar period, sex assigned at birth, and age were calculated.

Results  The 6 657 456 study participants (50.0% assigned male sex at birth) were followed up during 171 023 873 person-years. Overall, 3759 individuals (0.06%; 52.5% assigned male sex at birth) were identified as transgender at a median age of 22 years (IQR, 18-31 years) and followed up during 21 404 person-years, during which 92 suicide attempts, 12 suicides, and 245 suicide-unrelated deaths occurred. Standardized suicide attempt rates per 100 000 person-years were 498 for transgender vs 71 for nontransgender individuals (aIRR, 7.7; 95% CI, 5.9-10.2). Standardized suicide mortality rates per 100 000 person-years were 75 for transgender vs 21 for nontransgender individuals (aIRR, 3.5; 95% CI, 2.0-6.3). Standardized suicide-unrelated mortality rates per 100 000 person-years were 2380 for transgender vs 1310 for nontransgender individuals (aIRR, 1.9; 95% CI, 1.6-2.2), and standardized all-cause mortality rates per 100 000 person-years were 2559 for transgender vs 1331 for nontransgender individuals (aIRR, 2.0; 95% CI, 1.7-2.4). Despite declining rates of suicide attempts and mortality during 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), suicide-unrelated 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 individuals had significantly higher rates of suicide attempt, suicide mortality, suicide-unrelated mortality, and all-cause mortality compared with the nontransgender population.

Introduction

The prevalence of transgender individuals, defined as persons whose gender identity or gender expression does not conform to that typically associated with the sex to which they were assigned at birth,¹ varies greatly between studies. A meta-analysis of 27 international studies conducted between 1968 and 2014 reported a prevalence of less than 0.01% based on transgender-related diagnoses.² In a US survey from 2014, the proportion of individuals aged 13 years or older identifying as transgender was estimated at 0.6%,³ and in a nationally representative study conducted in Denmark in 2017 to 2018, 0.1% of those aged 15 to 89 years were estimated to be transgender.⁴

The first gender identity–affirming surgery in Denmark took place in 1952.⁵ Since 1968, individuals undergoing such surgery could get their recorded sex updated in the national Civil Registration System to reflect their gender identity. In 2014, a law was passed enabling all Danish residents aged 18 years or older to apply for legal change of gender regardless of whether hormone therapy or gender identity–affirming surgery had taken place.⁶ In 2017, new guidelines were implemented to make transgender health care more accessible.⁷

Prior studies suggest a higher risk of suicide attempt and suicide among transgender individuals than that observed in the general population.^8-13 However, the existing evidence is largely derived from clinical samples or surveys in which sampling or information bias cannot be excluded.^8,9,11-13 The aim of the present national cohort study was to provide an updated, robust assessment of whether transgender individuals identified from hospital records and records of legal change of gender have higher rates of suicide attempt and of suicide, suicide-unrelated mortality, and all-cause mortality than the population of nontransgender individuals when data were adjusted for potential confounding by calendar period, sex assigned at birth, and age.

https://jamanetwork.com/journals/jama/fullarticle/2806531?guestAccessKey=458dc50a-ea74-489c-bc68-c0128d48a4e3