What we do know about violence and violent deaths among trans people?
Every year as we approach the Transgender Day or Remembrance, we have a lot of conversations about numbers. As I note in another post, we do not have reliable mortality data on transgender people in the US. That means we can’t really calculate a “homicide rate,” because we just don’t have the data. The names and the numbers we have—47 this year so far—are simply the ones journalists and advocates have been able to identify from community members and press reports. We do know from government surveys and many other sources that trans people face non-fatal violence at very disproportionate rates. We need local, state, and federal governments to collect meaningful data, and we need more rigorous research to really understand the full picture—though we certainly know enough to take meaningful action and make investments in marginalized trans communities that can help prevent this violence.
There is one study I know of that has tried to actually measure mortality in a US trans population and compare it to cisgender people. This study was published this year and the data comes from veterans receiving VA care. Here’s the citation:
Taylor L. Boyer, Ada O. Youk, Ann P. Haas, George R. Brown, Jillian C. Shipherd, Michael R. Kauth, Guneet K. Jasuja, and John R. Blosnich, Suicide, Homicide, and All-Cause Mortality Among Transgender and Cisgender Patients in the Veterans Health Administration, 8 LGBT Health 173 (2021). http://doi.org/10.1089/lgbt.2020.0235.
I am not a research scientist, but here is my take on this study:
Key takeaways from this data:
This is the first US study to directly compare official mortality data of transgender and cisgender patients. Until the CDC begins routinely collecting trans demographics in its mortality data, pulling data from large sets of patient records is the best we can do.
It’s important to note that while the sample is relatively large (n = 32,441, of whom 8,112 were transgender 24,329 cisgender), it is not a general-population study. The data comes directly from Veterans Health Administration patient records, so it only represents military veterans who are eligible for VA care—on average, an older and sicker population. Still, VHA is a huge system and its population easier to study than patients in private care, and this first-of-its-kind data is invaluable.
In this sample of veterans in VHA care, transgender people across age groups were more than twice as likely to die by suicide during the 17-year study period, when accounting for other demographic factors. For those under 40 it was more than three times greater than cisgender peers, while for those over 65 it was more than nine times greater. Transgender veterans who did died at significantly younger ages than their cisgender peers.
In this veteran sample, transgender people were more likely to die by homicide than their cisgender peers. The average age at which they were killed did not differ significantly. This finding should be interpreted with caution because the total number of homicide deaths in the sample was very small. This is important as the first data of its kind, but much more research is needed.
The ten most common causes of death were the same for transgender and cisgender patients in the sample, with the ranking broadly similar except that suicide was the fourth leading cause of death for transgender people, whereas it was tenth for the cisgender sample and in the US overall.
Over the 17-year period studied and adjusting for other demographics, all-cause mortality among transgender people under 65 was lower than their cisgender peers—but for trans people over 65 it was higher than for cisgender people over 65. (This just means that they died for any reason during this 17-year period.) This mixed and generationally-divided result was unexpected, given that numerous studies have found disparities in both physical and mental health across age groups, including for some chronic conditions that are leading causes of death.
Key policy implications from this data:
The White House-led Interagency Working Group on Safety, Inclusion, and Opportunity for Transgender Individuals should produce a bold and specific action plan that is focused on root causes of prevention and is folded into broader gender, equity, and anti-violence efforts. State and local governments should do likewise. Just doing better counting or better investigations is not enough, and we can’t prosecute and incarcerate our way to ending violence. Despite the limitations of this data and the urgent need for more research, this is the first actual US comparative mortality we have, and it shows higher death by homicide among transgender people. Moreover, it is consistent with many other studies that have found transgender people are more likely to experience non-fatal violence across all areas of social life, including domestic, intimate partner, sexual, and hate violence (which often overlap).
Transgender youth need proactive equity and prevention efforts as well as strong civil rights enforcement, including outreach and technical assistance to schools and health providers and leveraging federal education and prevention funding and guidance to promote equity and safe-schools efforts. The Justice Department needs to make clear that it will take action against state laws that target trans youth. The Departments of HHS and Education need to place transgender youth front and center in suicide prevention and school safety initiatives. And the Administration can build on its current effort to fund and promote community-based violence prevention and intervention efforts by funding and incentivizing projects that focus on trans populations and violence against trans people.
Economic recovery programs and health system transformation efforts must include a focus on reaching transgender people, who were already facing 2020 unemployment rates in 2015 (per the US Trans Survey) and face barriers throughout the health care system. This means making real investments in both making existing programs and systems trans-inclusive and funding targeted, transgender-specific initiatives to promote economic opportunities and public health. The Biden Administration, Congress, states, and localities all need to take up this charge. President Biden has already promised to do this and should work with DOL, SBA, Commerce, and HHS to do it, including through implementation efforts for the COVID-19 recovery, infrastructure, and (hopefully) Build Back Better acts.
The Biden Administration should prioritize transgender data collection, including mortality and victimization data. Measures are missing from most key federal surveys. In some systems, such as the National Violent Death Reporting System, have the data fields but states and localities need help and encouragement to ensure it’s actually reported. A few key surveys collect this data but it hasn’t yet been publicly reported. Others need to further test Spanish-language and proxy questions. Agencies need clear standards and guidance from the White House. Congress should provide more funding for federal statistical agencies to support important efforts like these.
The Administration for Community Living/AoA should develop guidance, incentives, and resources to ensure that supports reach trans older adults and are nondiscriminatory and culturally competent, and should develop effective data collection measures to learn more about trans older adults’ experiences. State and local governments should do likewise. The finding here that trans older adults had higher all-cause mortality and extremely high death by suicide is consistent numerous other findings of mental and physical health disparities in trans older adults.
If you know of other important data or projects on these issues, let me know. Kudos, as always, to all the researchers and advocates moving this work forward.