Nationwide estimates of all-cause and cause-specific mortality among individuals with gender dysphoria in Sweden, 2001-2023: a register-based cohort study.

Authors

Kristen D Clark, Richard A White, Sarah S Jackson, Alkistis Skalkidou, Thomas Frisell, Fotios C Papadopoulos

Published in

EClinicalMedicine. Volume 98. Pages 104088. Epub Jul 31, 2026.

Abstract

Transgender and gender-diverse (TGD) people experience elevated mortality risk, yet population-based estimates of cause-specific mortality remain limited. Prior studies have focused on narrow subgroups or outdated cohorts, leaving gaps in understanding current mortality disparities. Therefore, the purpose of this study is to quantify all-cause and cause-specific mortality among all TGD adults with a diagnosis of gender dysphoria in Sweden.
This cohort study provides national cause-specific mortality estimates among TGD adults in Sweden using registry data (2001-2023). TGD people were identified using ICD-10 codes for "gender dysphoria" and matched to approximately 10 cisgender controls of each sex by age and county. Age-standardized mortality rates, absolute mortality risk differences, mortality rate ratios (MRR), and years of potential life lost (YPLL) were calculated overall and stratified by sex assigned at birth.
A total of 9038 TGD people were identified, among them, 211 deaths were observed. All-cause mortality risk was almost twice that of the cisgender comparison group (MRR = 1.9, 95% confidence interval [CI] 1.7, 2.2). Stratified analyses showed distinct mortality patterns for transfeminine (assigned male sex at birth) and transmasculine (assigned female sex at birth) people, with higher risk from ill-defined diseases among transfeminine people (cisgender women as reference: MRR = 4.9, 95% CI 2.3, 10.3; cisgender men: MRR = 5.5, 95% CI 2.6, 11.4) and transmasculine people from neoplasms (cisgender women: MRR = 2.4, 95% CI 1.4, 4.1; cisgender men: MRR = 1.8, 95% CI 1.1, 3.1). These disparities resulted in a mean of 6.3 YPLL for transfeminine people compared to cisgender men and 9.0 YPLL for transmasculine people compared to cisgender women.
These findings highlight persistent health inequities and underscore the need for targeted public health interventions and an evaluation of data collection processes to improve health monitoring and support TGD populations in Sweden.
The present study was funded by a Starting Grant (2023-01397) and a project grant (2021-01968) from the Swedish Research Council for Health, Working Life and Welfare (FORTE).

PMID:
42576911
Bibliographic data and abstract were imported from PubMed on 11 Aug 2026.

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