Summary
Swedish researchers found everyone diagnosed with gender dysphoria in national health records between 2001 and 2023, about 9,000 people who were about 25 on average when diagnosed. They compared deaths with men and women of the same age and county. Over about seven years, 211 people with gender dysphoria died, almost twice the death rate of the comparison groups after allowing for age. Extra deaths came from accidents, violence and suicide (suicide was not counted on its own), from unclear causes, from mental and brain conditions such as drug or alcohol problems, and from cancer in people born female. The authors call for public health action but say the records cannot explain why. Nothing beyond age and county was taken into account, and many causes had very few deaths. So the study shows a gap in deaths but not what causes it.
Key findings
- این مطالعه 9,038 نفر را که در 2001–2023 در سوئد تشخیص دیسفوریای جنسیتی گرفتند (4,181 مردمتولد، 4,857 زن‌متولد) در مقایسه با 179,816 نفر هم‌سن و هم‌شهرستان پوشش داد.
- 211 مرگ رخ داد؛ پس از احتساب سن، نرخ مرگ 183 در برابر 96 در هر 10,000 نفر در سال بود، حدود دو برابر.
- در میان مردمتولدها، نرخ مرگ 2.3 برابر زنان و 1.6 برابر مردان بود، با مرگ بیشتر از تصادف، خشونت و خودکشی (3.2 و 2.5 برابر)، علل نامشخص (حدود 5 برابر) و بیماری‌های روانی یا مغزی (3.6 و 2.6 برابر).
- در میان زن‌متولدها، نرخ مرگ 2.1 برابر زنان و 1.7 برابر مردان بود، با مرگ بیشتر از تصادف، خشونت و خودکشی (2.2 و 1.5 برابر) و سرطان (2.4 و 1.8 برابر).
- خودکشی، قتل و تصادف با هم علت 76 مرگ از 211 مرگ (36%) بودند، اما خودکشی به‌تنهایی گزارش نشد.
- به‌طور میانگین هر مرگ برای مردمتولدها 6 سال زودتر (در مقایسه با مردان) و برای زن‌متولدها 9 سال زودتر (در مقایسه با زنان) رخ داد.
- نویسندگان می‌گویند یافته‌ها نقطهٔ آغازی برای پیگیری مرگ‌ها هستند، نه شاهدی دربارهٔ علل یا اثرات درمان.
Abstract
BACKGROUND: Transgender and gender-diverse (TGD) people experience elevated mortality risk, yet population-based estimates of cause-specific mortality remain limited. Prior studies have focused on narrow subgroups or outdated cohorts, leaving gaps in understanding current mortality disparities. Therefore, the purpose of this study is to quantify all-cause and cause-specific mortality among all TGD adults with a diagnosis of gender dysphoria in Sweden. METHODS: This cohort study provides national cause-specific mortality estimates among TGD adults in Sweden using registry data (2001-2023). TGD people were identified using ICD-10 codes for "gender dysphoria" and matched to approximately 10 cisgender controls of each sex by age and county. Age-standardized mortality rates, absolute mortality risk differences, mortality rate ratios (MRR), and years of potential life lost (YPLL) were calculated overall and stratified by sex assigned at birth. FINDINGS: A total of 9038 TGD people were identified, among them, 211 deaths were observed. All-cause mortality risk was almost twice that of the cisgender comparison group (MRR = 1.9, 95% confidence interval [CI] 1.7, 2.2). Stratified analyses showed distinct mortality patterns for transfeminine (assigned male sex at birth) and transmasculine (assigned female sex at birth) people, with higher risk from ill-defined diseases among transfeminine people (cisgender women as reference: MRR = 4.9, 95% CI 2.3, 10.3; cisgender men: MRR = 5.5, 95% CI 2.6, 11.4) and transmasculine people from neoplasms (cisgender women: MRR = 2.4, 95% CI 1.4, 4.1; cisgender men: MRR = 1.8, 95% CI 1.1, 3.1). These disparities resulted in a mean of 6.3 YPLL for transfeminine people compared to cisgender men and 9.0 YPLL for transmasculine people compared to cisgender women. INTERPRETATION: These findings highlight persistent health inequities and underscore the need for targeted public health interventions and an evaluation of data collection processes to improve health monitoring and support TGD populations in Sweden. FUNDING: The present study was funded by a Starting Grant (2023-01397) and a project grant (2021-01968) from the Swedish Research Council for Health, Working Life and Welfare (FORTE).
Conclusion
These findings highlight persistent health inequities and underscore the need for targeted public health interventions and an evaluation of data collection processes to improve health monitoring and support TGD populations in Sweden. The authors note that registry data cannot distinguish whether excess deaths result from biological factors, behavioural risks, systemic barriers or administrative biases. They state that future research linking clinical treatment records to mortality is required, and that the findings serve primarily as a baseline for monitoring mortality trends rather than evidence of specific causal pathways.