Comparing radiologically evident injuries among cisgender and transgender women

Despite the high prevalence of violence among transgender and gender-diverse individuals, injury disparities remain understudied and are often attributed to underreporting. To address this limitation, we analysed radiology reports to objectively compare the prevalence and patterns of injuries between transgender women and cisgender women.

We used the Research Patient Data Registry at a level 1 trauma centre in the USA to identify 263 transgender women and 525 age-matched, race-matched and ethnicity-matched cisgender women. Adjusted incidence rate ratios (aIRR) and ORs were calculated to compare imaging and injury patterns. Two radiologists, blinded to patients' gender identity, assessed the presence and type of injuries based solely on radiology reports. Electronic medical records were reviewed for all patients with radiologically evident injuries.

In our cohort, 25.4% of cases sustained 141 injuries (67/263), compared with 14.7% of controls with 98 injuries (77/525). Injury rates were significantly higher among transgender women (aIRR: 3.3 (2.5-4.3), p<0.01), particularly for cranial (7.8 (2.1-29.1), p<0.01), facial (36.4 (8.6-153.8), p<0.01) and thoracic injuries (4.9 (1.4-17), p=0.01). Notably, 78.9% of facial fractures (15/19) involved the midface. Transgender women were also more likely to undergo imaging in emergency departments compared with cisgender women (OR: 5.3 (3.3-8.3), p<0.01).

Transgender women experience significantly higher injury rates, particularly to the head, face and chest and more frequently present to emergency departments.