跨性别人群死亡率:台湾匹配人口和兄弟姐妹对比队列研究
Chih-Wei Hsu1, Yang-Chieh Brian Chen2, Liang-Jen Wang3
1Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
The Lancet regional health. Western Pacific
|October 29, 2025
概括
与人口对照相比,变性人面临更高的全因和自杀死亡率. 家庭内部的比较显示,自杀风险持续存在,这凸显了有针对性的心理健康和安全干预的必要性.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 跨性别者健康 跨性别者健康
背景情况:
- 变性人群的死亡率较高,但现有的证据往往缺乏家族混分析,主要来自西方国家.
- 了解跨性别个体的死亡风险需要强大的研究设计,考虑到潜在的家庭和社会因素.
研究的目的:
- 调查台湾跨性别人群中所有原因,外部原因 (自杀,意外) 和内部原因死亡率.
- 通过使用匹配的人口控制和家庭内兄弟姐妹比较,区分人口层面的风险和对死亡率的家族影响.
主要方法:
- 一项全国性的回顾性队列研究,涉及3906名跨性别个人和15624名匹配的人口对照,对4765名 cisgender 兄弟姐妹进行了二次分析.
- 利用精神科医生记录的性别认同障碍诊断来确定队列,并跟踪参与者直到死亡或2022年12月31日.
- 使用考克斯回归,调整社会人口统计和医疗并发症,以比较跨性别个人和对照/兄弟姐妹之间的死亡率结果.
主要成果:
- 与人口对照人群相比,变性人群的全因死亡率 (HR 1.40) 和外部原因死亡率 (HR 2.03) 显著增加,主要原因是自杀风险大幅增加 (HR 4.07).
- 家庭内兄弟姐妹的比较表明,虽然全因死亡和意外死亡风险没有增加,但自杀风险仍然显著增加 (HR 2.57).
- 高死亡风险,特别是自杀风险,在女性合法性别的跨性别个人和青少年中最为明显. 在跨性别群体中,精神疾病的比例过高.
结论:
- 与普通人口相比,台湾的跨性别者经历了较高的全因和自杀死亡率,即使考虑到共同的家庭因素,自杀风险仍然存在.
- 这些发现强调了有针对性的心理健康和安全干预措施的迫切需要,特别是针对女性合法性别的青少年和跨性别人士.
- 虽然家庭因素可能起到作用,但持续的过度自杀死亡率表明,社会和个人层面的重大影响需要有针对性的公共卫生战略.
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