title: Mortality Among Veterans with Transgender-Related Diagnoses in the Veterans Health Administration, FY2000-2009.
abstract: OBJECTIVE
  The aims of this project were to document all-cause and suicide mortality among Veteran Healthcare Administration (VHA) utilizers with The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis consistent with transgender status.
  
  
  METHODS
  The study population consisted of VHA patients identified as having any one of four diagnosis codes indicating transgender status (n=5,117) gathered from the VA National Patient Care Database. Mortality data were gathered from the National Death Index from 2000-2009 for 1,277 veterans with transgender-related ICD-9-CM diagnoses. The remaining 3,840 were not searched because they had VHA utilization after 2009 (indicating they were alive). Person-time at risk (person-years) for crude rates were calculated based on the time from an individual's index diagnosis to either death or the end of FY 2009. Causes of death were categorized using ICD-10 code groups.
  
  
  RESULTS
  Approximately 9.3% (n=309) veterans with transgender-related ICD-9-CM diagnoses died across the study period. Although diseases of the circulatory system and neoplasms were the first and second leading causes of death, respectively, the other ranked causes of mortality differed somewhat from patterns for the US during the same time span. The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses across the 10-year period was approximately 82/100,000 person-years, which approximated the crude suicide death rates for other serious mental illness in VHA (e.g., depression, schizophrenia). The average age of suicide decedents was 49.4 years.
  
  
  CONCLUSIONS
  The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses is higher than in the general population, and they may be dying by suicide at younger ages than their veteran peers without transgender-related ICD-9-CM diagnoses. Future research, such as age-adjusted rates or accounting for psychiatric co-morbidities, will help to better clarify if the all-cause and suicide mortality rates are elevated for veterans with transgender-related ICD-9-CM diagnoses.
authors.affiliation: 1 VA Pittsburgh Healthcare System , Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania.|2 Department of Psychiatry, University of Rochester , Rochester, New York.|3 Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: John R
authors.initials: JR
authors.lastname: Blosnich
authors.affiliation: 4 Office of Health Equity , VA Central Office, Washington, D.C.|5 Department of Psychiatry and Behavioral Sciences, East Tennessee State University , Johnson City, Tennessee.
authors.forename: George R
authors.initials: GR
authors.lastname: Brown
authors.affiliation: 6 VISN2 Center of Excellence for Suicide Prevention, Canandaigua, New York.
authors.forename: Sybil
authors.initials: S
authors.lastname: Wojcio
authors.affiliation: 4 Office of Health Equity , VA Central Office, Washington, D.C.
authors.forename: Kenneth T
authors.initials: KT
authors.lastname: Jones
authors.affiliation: 2 Department of Psychiatry, University of Rochester , Rochester, New York.|6 VISN2 Center of Excellence for Suicide Prevention, Canandaigua, New York.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Bossarte
keywords: mortality; suicide; transgender persons; veterans