Transgender and Nonbinary Deaths Investigated by the State Medical Examiner in the Portland, Oregon, Metro Area and Their Concordance With Vital Records, 2011-2021

Abstract

Objectives: To illustrate possible improvements in recording of gender identity, we investigated discrepancies between gender identity from medical examiner (ME) death investigations and sex as recorded in the final death record. Design: Evaluation of a database used to record information related to medicolegal death investigation with matching to state vital records. Kappa analysis was used to measure concordance between both systems. Setting: The Portland, Oregon, metro area (Clackamas, Multnomah, and Washington Counties) and deaths investigated by the Offices of each County Medical Examiner between January 2011 and September 2020. Intervention: Epidemiologists identified incongruous data that have significant negative implications for transgender populations. Epidemiologists identified key actions that, if taken by death investigators, death record software, and the federal death certificate form, will rectify harmful data discrepancies. Main Outcome Measure: Concordance of gender identity and sex in ME data and death record, respectively. Results: We identified 51 deaths in transgender persons; the majority were classified as transgender female (71%). The κ statistic was −0.0657, indicating poor concordance between the gender identity in ME investigation and the death certificate in vital records. Conclusions: Information gathered via medicolegal death investigations is foundational to effective public health/public safety response; MEs and coroners are often the first to document emerging health threats. Discrepancies in official death records impede accurate surveillance of a population disproportionately at risk of violent death.

The Gay and Trans Panic Defense: Focusing on the Homicides, Not the Court Room Strategy

“…The Federal Bureau of Investigation (FBI), for example, counts the murders of transgender people but does not record their gender as trans. Some local government agencies in large cities such as Los Angeles (Stotzer, 2008) and Portland (Walters et al, 2023) track transgender murders and deaths, but no consensus exists between cities or regional areas about how to define people who are transgender and gender non-conforming (Collin et al, 2016), making it difficult to generalize these data across these cities. Recently, the United States National Death Index, which tracks all deaths in America, has attempted to capture the deaths of transgender people in their records (Fouché et al, 2022).…”

Operationalizing the structural vulnerability profile within the medical examiner context

“…Examples of these differences may include whether CT or radiographic images are taken and analyzed, and whether demographic data like social race, gender, and sex are attributed, versus describing observed skin tones and external genitalia. These recording differences may also vary depending on jurisdiction; for example, standardized forms might conflate social identities, such as gender, with biological classifications, such as sex, and be aggregated into recording systems whose structural rigidity prevents appropriate documentation of transgender or nonbinary decedents [ 4 ]. In mixed ME/coroner jurisdictions, officially reported demographic data such as race and gender may come directly from the coroner and conflict with observations made during examination.…”

Shifting the Forensic Anthropological Paradigm to Incorporate the Transgender and Gender Diverse Community

“…Therefore, TGD persons may be misgendered (addressed using pronouns or forms of address that do not reflect their gender identity) or deadnamed (referred to by the name they used prior to transitioning) in missing person reports by someone unaware or unsupportive of the decedent's gender identity. Discrepancies between antemortem records and postmortem findings during the death investigation can impede the identification and return of remains [10,63]. The death investigation process and identification efforts are likely to uncover a deadname for those who have socially, but not legally, changed their name and/or gender designation.…”