Orientação sexual e identidade de gênero: análise de sobrevida a partir da notificação de óbitos por violência no Estado do Rio de Janeiro

Abstract

The field of public health, understood as a social space of dispute and power (Bourdieu, 1983), demonstrates its significance by incorporating elements of individual and collective subjectivity into the social determinants of health. When examining the specificities surrounding sexual orientation and gender identity within social groups, gender inequality, discrimination, and prejudice emerge as key terms for understanding violence phenomena. The general objective of this study is to analyze the effect of sexual orientation and gender identity on mortality and violence databases in the State of Rio de Janeiro from 2015 to 2020. The method employed is an observational cohort study with a non-concurrent passive follow-up. In this study, the technique of probabilistic data linkage was applied between notifications of interpersonal violence and deaths due to violent causes in the State of Rio de Janeiro, covering the period from June 15, 2015, to December 31, 2020. Among the results, 1556 death records related to 80,178 violence notifications formed the cohort base. Proportionally, external causes accounted for 48.59% (n=756) of all deaths recovered in the data linkage. It is noteworthy that trans women have a 4.07 times higher risk of dying from violent causes than cisgender and heterosexual women. Furthermore, cisgender and heterosexual men have a much higher risk (HR 10.13; 95% CI: 7.04-14.59) than cisgender and heterosexual women. Transgender men had an elevated risk, but the statistical relationship is borderline (p-value 0.053). Regarding overall mortality, an increase in rates is observed concerning age, sexual orientation, male gender assigned at birth, black and brown (negro) race, lower educational attainment, marital statuses other than being single, the presence of physical and mental disabilities, recurrences in notification/follow-up, and referrals to other points in the healthcare network. Finally, the adjusted survival curve for each study group of interest indicates a noticeable reduction in survival over time, especially in groups with male identities, in transgender individuals, and in trans women. The power of social change is possible with the premise that knowledge and information are embraced by all, especially for those in social realities that are not conducive to life. The empowerment and strengthening of the LGBTQIA+ community prove to be important tools in resisting social inequalities. It is hoped that the results obtained from this study can inspire researchers, both LGBT and non-LGBT, to be concerned about the insecure life scenario of this population. Rebellion is necessary.