Mortality among transgender folk

Conservative forces are concerned that the National Institutes of Health have awarded $189,186 to Emory University to study transgender mortality (project information).

PUBLIC HEALTH RELEVANCE: The purpose of this study is to determine whether transgender persons defined as those who medically change the gender assigned to them at birth (male to female or female to male) have higher or lower risk of death and certain diseases than men and women that do not consider themselves transgender.  Participants will be selected from medical records of two large health care systems – the Veterans Affairs Administration and the Kaiser Permanente. Transgender persons will also be asked to join focus group discussions and share their views about factors that may motivate or preclude their participation in research.

Members of the transgender community and health care providers caring for transgender individuals express concerns about mental and physical health problems in this population; however longitudinal studies of transgender populations in the US have not been conducted.

CNS (which is Cybercast News Service, even though many think of it as Christian News Service) felt it necessary to inquire as to whether this was an “effective use of taxpayer funds.”

The NIH funded project began in August, 2013 and runs through May 2015

The Daily Caller felt it necessary to highlight a conclusion that transgender military veterans have a suicide rte comparable to that of people with schizophrenia and to that of people with serious depression.

The research of the general population of transgendered individuals (TIs) so far indicates a troubled and disturbed community. Suicidal ideation, that is, a mental obsession with suicide, reaches up to 60 percent in the general transgender population, and the risk of attempted suicide is fixed at 30 percent. The 30 percent figure has remained stable over multiple studies in Europe, although much more evidence is available regarding violence, rates of HIV infection, smoking, and prison time.

–Jonah Bennett, Daily Caller

In this case, researchers looked at a sample of 3,327 transgendered veterans over a period of 10 years, from 2000 to 2009, finding that the overall suicide rate was 82/100,000 person-years, a figure calculated by taking the number of incidences in a population and dividing it over time. The average age of suicide for transgendered veterans was 49.4 years of age. Researchers used data from Veterans Affairs databases, since there are far more TIs in the military population, compared to the general population.

Overall veteran suicide rates are only at 37.7/100,000 person-years. When combined with factors like substance abuse and schizophrenia, the rates jump up to 81.2 and 83.3, with schizophrenia just edging over the category of transgender as a cause of suicide. What makes the transgender population distinct is that suicides occurred at an even younger age than veterans who committed suicide as a result of suffering from schizophrenia.

–Bennett

Bennett apparently read Mortality Among Veterans with Transgender-Related Diagnoses in the Veterans Health Administration, FY2000-2009 before writing his article.

Although transgender individuals bear high burdens of several threats to physical health, including interpersonal violence, HIV infection, incarceration, and smoking, there is very little information about mortality among trans-gender populations.  The few studies that exist come from European countries and conclude that suicide is a more prevalent cause of death among members of this group than in the population at large. In an 18-year follow-up study of 1,331 transsexual persons in the Netherlands, Asscheman and colleagues noted that male-to-female (MtF) individuals had over 5 times the risk of dying by suicide than the general population; female-to-male (FtM) individuals were over twice as likely to die by suicide.  Similarly, Dhejne et al. found that transsexual persons in a 30-yr follow-up study in Sweden were nearly 20 times more likely to die by suicide than the general Swedish population.  To date, there are no studies on mortality among transgender samples in the U.S., however a recent study of VHA Veterans diagnosed with GID found a much higher rate of non-fatal suicide behaviors when compared with the VHA general population.

–Blosnich, et. al.

Wingers like to use the Swedish study to back their claim that treating transgender people medically increases the risk of suicidal behavior.

The Blosnich study (Table 1) found that of the 309 VHA veterans with qualifying psychiatric diagnosis who died between FY2000 and FY2009, 29.1% died of diseases to the circulatory system, 21.0% from neoplasms (benign or cancerous), 12.9% from external causes, 12.3% from respiratory diseases, 6.8% from digestive system diseases, 3.9% from infectious or parasitic diseases, 3.9% from endocrine, nutritional or metabolic diseases, 3.2% from diseases of the the nervous system, 2.6% from mental, behavioral and neurodevolopmental disorders, and 4.2% all other.  There were 3327 qualified participants in the study, so approximately 9.3% of them died.

A second table (Table 2) analyzed suicide mortality rates, finding that 15 of the 309 deceased VHA veterans with qualifying psychiatric diagnosis committed suicide over the study period, which works out to 5% of the deaths, as far as I can see…and would only be 0.5% of the qualified participants.  The average age of suicide death was 49.4.

That leaves a big question as to why Bennett entitled his article 10 Percent Died During Study Of Veteran Transgender Suicide, since it was, indeed the fact that 9.3% died, but the vast majority had nothing to do with suicide.

The crude over-all suicide rate across the 10-year period was approximately 82/100,000 person-years.

I think I need to have that statistic explained to me…but Bennett ran with it as proof of…something.

The results of these analyses suggest that, in addition to higher incidence of suicide-related events (e.g., serious suicidal ideation, suicide attempt, suicide plans) documented in a previous study,  the overall crude rate of suicide among veterans with transgender-related ICD-9-CM diagnoses (82/100,000 person-years) is higher than both the crude rates among the VHA in general and the U.S. population in general.  For example, Ilgen et al. examined suicide mortality among VHA veterans from FY1999-2006, and noted that the crude rate was 37.7/100,000 person- years.  Across that period, VHA veterans with any psychiatric diagnosis had a crude suicide rate of approximately 70/100,000 person-years.  The crude rate for this sample of veterans with transgender-related ICD-9-CM diagnoses approximated the crude suicide death rates for other psychiatric conditions in VHA, such as veterans with any substance abuse/dependence diagnosis (81.2/100,000 person-years), depression (81.8/100,000 person-years), or schizophrenia (83.3/100,000 person-years).  It is possible that while veterans with transgender-related ICD-9-CM diagnoses have a higher risk of suicide death than the VHA in general, the suicide rate is similar to veterans with other serious psychiatric diagnoses.  More sophisticated calculations, such as age-adjusted rates or accounting for psychiatric co-morbidities, would help to better clarify if the all-cause and suicide mortality rates are elevated for veterans with transgender-related ICD-9-CM diagnoses. However, said calculations would need to be carefully constructed given the very small sample of suicides (n = 15) that occurred across the period examined.

Ah, Mr. Bennett…now I see what you did there.

I presume Mr. Bennett will be teaching a graduate-level class in how to cherry-pick data very soon.