ArticleThe Lancet regional health. Western Pacific2025
Mortality among transgender persons: a Taiwan matched-population and sibling-comparison cohort study.
Article in The Lancet regional health. Western Pacific, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Laparoscopic-assisted versus conventional vaginal hysterectomy for gender-affirming surgery in female-to-male transgender men.Journal of the Chinese Medical Association : JCMA · 2026Article
- All-cause and cause-specific mortality in gambling disorder: Evidence from a nation-wide matched and sibling cohort study in Taiwan.Addiction (Abingdon, England) · 2026Article
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Authors and funding
8 authors.
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Abstract
Background: Transgender persons have been reported to experience excess mortality, but evidence is dominated by Western cohorts and seldom addresses familial confounding. Methods: We conducted a nationwide, retrospective cohort study using two prespecified comparison designs: matched population controls (1:4, matched on legal sex and birth date) and within-family cisgender sibling comparisons. Transgender persons were identified by ≥2 psychiatrist-recorded gender identity disorder diagnoses during 2001-2021; cohort entry required age ≥6 years. Participants were followed until death or December 31, 2022. We compared all-cause, external-cause (suicide and accidents), and internal-cause mortality using Cox regression adjusted for sociodemographics and medical comorbidity. Findings: Among 3906 transgender persons (mean age 24.6 years; 70.6% with a male legal sex) and 15,624 controls (mean follow-up 9.5 years), psychiatric conditions were markedly over-represented in the transgender cohort (e.g., depressive disorders 40.8% vs 5.7%). Adjusted hazard ratios were 1.40 (95% confidence interval 1.06-1.84) for all-cause mortality, 2.03 (1.39-2.96) for external causes, and 4.07 (2.52-6.59) for suicides; accidents (0.56, 0.21-1.45) and internal-cause (0.98, 0.65-1.48) mortality did not differ. In sibling comparisons (4765 siblings), excess all-cause and external-cause mortality were not observed (0.96, 0.67-1.36; and 1.14, 0.70-1.85), suicide risk was higher (2.57, 1.32-5.00), and accident mortality lower (0.19, 0.06-0.67). Relative hazards were greatest in those with a female legal sex and in adolescents. Adjustment for psychiatric clusters attenuated-but did not eliminate-the suicide mortality excess. Interpretation: In Taiwan, transgender persons had higher all-cause and suicide mortality than population controls; in within-family comparisons, the suicide mortality excess persisted, indicating influences beyond shared familial factors. Prevention should prioritize targeted mental-health and safety interventions, with particular attention to adolescents and those with a female legal sex. Funding: Taiwan National Science and Technology Council.
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