Causes of death of transgender and gender diverse veterans.

INTRODUCTION: Transgender and gender diverse (TGD) veterans face numerous challenges due to stigma and marginalization, which have a significant impact on their health and well-being. However, there is insufficient data on cause-specific mortality in TGD veteran populations in the United States. The purpose of this study was to describe the leading causes of death in a sample of TGD veterans who received care from the Veterans Health Administration (VHA).

METHODS: A secondary data analysis was conducted using VHA electronic health record (EHR) data matched with death certificate records from the National Death Index (NDI) from October 1, 1999 to December 31, 2019. Using record axis codes from NDI data, the 25 most frequent underlying and all causes of death were summarized.

RESULTS: Deaths occurred in 1,415 TGD veterans. Ranking by any mention on the death certificate, mental and behavioral disorders due to psychoactive substance use (17.2%), conduction disorders and cardiac dysrhythmias (15.3%), chronic obstructive pulmonary disease (15.1%), diabetes mellitus (13.9%), and chronic ischemic heart disease (13.3%) were the top five causes of death. Three distinct methods of suicide appeared as the 7th (firearms), 17th (self-poisoning), and 24th (hanging) underlying causes of death for TGD veterans.

CONCLUSIONS: Targeted prevention efforts or interventions to reduce the frequency and severity of causes of death, particularly mental and behavioral health disorders and metabolic disorders could prevent premature mortality among TGD adults.