YSPH Biostatistics Seminar: “Depression and Mortality among Transgender and Gender Diverse and Cisgender Veterans: A Differential Association of Risk by Gender Modality"

NOTE: BIS 525 students are required to attend in person. Others are invited to attend in person, but may also attend via Zoom.

SPEAKER: Hill Wolfe, PhD, MPA, Research Affiliate - Yale University - Department of Biomedical Informatics & Data Science

TITLE: “Depression and Mortality among Transgender and Gender Diverse and Cisgender Veterans: A Differential Association of Risk by Gender Modality"

ABSTRACT: Background: Transgender and gender diverse (TGD) individuals have elevated mental and physical health disparities, and a greater mortality risk compared to their cisgender (non-TGD) counterparts. Methods: In a recent study, differences were examined in the association of depression with all-cause and cardiovascular disease (CVD) mortality among TGD and cisgender veterans. A sample of 8981 TGD veterans, matched 1:3 with cisgender veterans (n = 26,924), was created using Veterans Administration electronic health record data linked with death certificate records from the National Death Index from October 1, 1999 to December 31, 2016. Cox proportional regression models stratified by gender modality (i.e., TGD and cisgender) were used to assess the hazard of all-cause and CVD mortality associated with a history of depression. Results: A total of 10,962 veterans died during the study period, including 1415 (15.8 %) TGD veterans and 9547 (35.5 %) cisgender veterans. Compared to cisgender veterans, TGD veterans had a significantly younger age of all-cause mortality (mean age: 58.1 years, SD = 12.5 years vs. 69.9 years, SD = 12.3 years; p < 0.001). Adjusted models demonstrated that depression was significantly associated with a greater hazard of all-cause mortality among both TGD (aHR:1.18, 95 % CI: 1.04–1.34) and cisgender (aHR:1.22, 95 % CI: 1.17–1.28) veterans. In age-stratified models, among veterans aged 45–64 years, depression was associated with a 21 % excess hazard of all-cause mortality among TGD veterans (aHR:1.21, 95 % CI: 1.02–1.44) and 13 % excess hazard among cisgender veterans (aHR:1.13, 95 % CI: 1.04–1.22). Among veterans aged ≥65 years, depression was significantly associated with a greater hazard of CVD mortality among cisgender veterans (aHR = 1.23, 95 % CI = 1.13–1.35) but not for TGD veterans. Findings for TGD veterans showed a similar pattern, though results were not significant. Conclusion: Future work should assess the equity of reach, quality, and outcomes of treatment for depression for TGD populations given the lack of attention to addressing the needs of this important demographic.

YSPH values inclusion and access for all participants. If you have questions about accessibility or would like to request an accommodation, please contact Charmila Fernandes at Charmila.fernandes@yale.edu. We will try to provide accommodations requested by October 3, 2024.