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 [kappa] 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.