Because decedents’ gender identity and sexual orientation are not routinely and systematically identified at the time of death, we do not know whether LGBT people die as a result of suicide and violence at a higher rate than the general population. Neither do we know what subgroups of LGBT people bear the greatest burden of violence-related mortality.
An estimated nine million Americans, about 4% of the overall U.S. population, identify as lesbian, gay, bisexual, or transgender (LGBT), and a substantially higher number, likely over 20 million Americans have engaged in same-sex sexual behavior in their lifetime or consider themselves to be a different gender than was assigned to them at birth. In recent years, methodologically sound studies have consistently found higher rates of suicidal thoughts, suicide planning, and suicide attempts in LGBT people compared to the general population. LGBT people are also more likely than others to report being a victim of violence involving childhood adversity and sexual abuse, bullying and other forms of peer victimization, as well as physical and sexual assault in adulthood. However, because decedents’ gender identity and sexual orientation are not routinely and systematically identified at the time of death, we do not know whether LGBT people die as a result of suicide and violence at a higher rate than the general population. Neither do we know what subgroups of LGBT people bear the greatest burden of violence-related mortality.
The Centers for Disease Control and Prevention’s (CDC) National Violent Death Reporting System (NVDRS), aggregates official records of violent deaths, including Death Certificates, medical examiner/coroner’s reports, law enforcement reports, and crime laboratory findings. NVDRS aims to improve understanding about why violent deaths occur, who is most affected, and how these deaths can be prevented. NVDRS data also play a critical role in guiding state and local agencies and officials as they develop, implement, and evaluate violence prevention programs, policies and practices. Among the NVDRS data elements are a number of variables related to sexual orientation and gender, the coding of which relies almost completely on the medical examiner/coroner’s report. As with all national surveillance systems, the quality of the NVDRS database depends entirely on the skill, perseverance, and commitment of the personnel who collect the information about each death.
The project on Postmortem Collection of Sexual Orientation and Gender Identity Data developed out of a two-day consensus meeting co-sponsored by the Johnson Family Foundation (JFF) and the American Foundation for Suicide Prevention (AFSP). The purpose of the meeting was to explore strategies for obtaining systematic postmortem sexual orientation and gender identity (SOGI) data on persons who die by suicide and other forms of violence, and propose a concrete plan for initial implementation. In addition to the host organizations, groups represented at this meeting included the National Action Alliance for Suicide Prevention (NAASP), Centers for Disease Control and Prevention (CDC), the National Violent Death Reporting System (NVDRS), the National Association for Public Health Statistics and Information Systems, the National Association of Medical Examiners, Offices of the Chief Medical Examiner and Chief Coroner in a number of jurisdictions in the U.S. and Canada, and the American Board of Medicolegal Death Investigators (ABMDI). Key among the consensus recommendations (published in LGBT Health in March 2015) was the call for an initial pilot project to develop and begin testing a protocol for death investigators to use in collecting SOGI information on individuals who die by suicide and other violent means. Also recommended was the project’s linkage to CDC’s National Violent Death Reporting System (NVDRS) so that its outcomes could eventually be determined by the quality of SOGI information included in local jurisdictions’ medical examiner/coroner reports, as accessed and reviewed by the state’s VDRS.
Given these recommendations, we are currently developing and testing methods for SOGI mortality data collection with death investigators in the field. We hope that this feasibility testing will help inform the practices of death investigators and local jurisdictions.