PORTLAND, Ore. (KOIN) – A new study conducted by epidemiologists from Multnomah, Washington and Clackamas counties found that more than half of transgender and non-binary people who died between 2011 and 2021 were misgendered on their death certificates. 

The findings were published in a paper in the Journal of Public Health Management & Practice. It focused transgender and nonbinary deaths in the Portland metro area and if they were consistent with vital records. 

County officials say discrepancies between the two can come with a price. 

Death certificates are used to determine a region’s vital statistics, which can determine how federal and state resources are allocated for things like social services and public health programs. 

“What we learned will likely alarm anyone who identities as transgender or nonbinary – or anyone who cares about the rights of transgender and gender nonconforming people,” said Kimberly Repp, chief epidemiologist for Washington County and co-author of the study. “When a population is not counted, it is erased.” 

The study explains that transgender people already face increased health risks and disparities compared to non-transgender populations and that this is another barrier that could harm them. 

The researchers cited several obstacles that stand in the way of correctly identifying transgender and non-binary people in state and federal health data. 

First, most coroner and medical examiner case management software does not include a field for gender identity. 

Second, there is no national requirement for death investigators to undergo training on how and why to capture information about a deceased person’s gender identity. 

And third, next-of-kin, who may not support the deceased person’s gender identity, have the power to declare the person’s sex on a death certificate. This process is known as nonconsensual detransitioning. 

Repp, together with her co-authors Jaime Walters, a senior epidemiology research associate with Multnomah County Public Health, and Molly Mew, a population epidemiologist with Clackamas County Public Health, conducted their study by identifying 51 deaths of transgender people in the tri-county area from January 2011 through September 2021. 

They used the narrative section of the medical examiner reports to determine if the people were transgender, since there is no field in the medical examiner case management software to record this information. 

This information was then compared to the official death certificates for 47 of the deaths. 

In an ideal world, researchers said the two records should match. But instead, they found there was no agreement between the two. More than half of the people, 29 out of 47, were misgendered on their death certificates. The highest error rate occurred in transgender women. 

Out of the 33 transgender females who died between 2011 and 2021, 20 were identified as male on their death certificates. 

“If you are a transgender person in the Portland Metro area there are no formal systems in place to ensure that your gender identity will be honored at the time of your death,” Repp said.

Kimberly DiLeo, the chief investigator with the Multnomah County Medical Examiner’s Office, demands change. 

“Our office has strongly advocated for appropriate changes within the database and we have been proactive in training our staff to record gender identity,’’ DiLeo said. “We are also working to provide formal training for the tri-county region, but without adequate tools to collect this data and changes at a national level, we are limited in what we can do.” 

While research shows that transgender and non-binary people are more likely to become victims of homicide and suicide, researchers cannot establish the extent of those disparities because no agency routinely collects this information about gender identity at death. 

The software Oregon contracts to use for tracking its death investigations offers hundreds of data fields, including if the death occurred on an Indian reservation or within city limits; the decedent’s hair, eye and skin color; and whether the person was an undocumented border crosser or had sex for money or drugs. 

But in the field for describing someone’s sex or gender, only three options are available: male, female or unsure. Unsure is used only in cases where the sex cannot be determined from the state of the remains. 

Death investigators are trained to complete the sex field using information found on the person’s license or by using any physical identification found at the scene. 

The researchers in this study say that a national survey found few transgender people go through the process of changing their government identification to match their gender identity. That means the sex on the legal identification is likely to be inaccurate. 

The researchers recommend there be laws enacted that require the recording of a person’s gender identity, not just their sex. 

They’d also like to require death investigators and funeral directors to attend a formal training on how and why to collect gender identity information, and give funeral directors the power to use gender identifying documentation enacted by the decedent prior to death specifying their gender identity, rather than relying solely on next-of-kin. 

Watch AM Extra’s interview with Kim Repp