"As a privileged, white, cis female, seeing this was devastating," Washington County epidemiologist Kimberly Repp said in an interview of her and other county epidemiologists' research results.

Portland area health officials are calling for change after finding that death certificates misgendered more than half of transgender or nonbinary people who died in the decade ending last year.

A combined research effort by Multnomah, Washington and Clackamas county epidemiologists, published Aug. 31 in the Journal of Public Health Management & Practice and made available to the public free of charge for two weeks starting Wednesday, found that nearly 30 Portlanders' gender identities were erased after death because there is no system to ensure those identities are recorded when people die.

The accuracy of death records is important not only for individuals and families but because they are used for research and can affect how federal money is directed. While previous studies have shown transgender people are more likely to die by suicide and homicide, for example, the data is limited because neither Oregon nor the federal government have systems to track gender identity upon death.

"As a privileged, white, cis female, seeing this was devastating," Washington County epidemiologist Kimberly Repp said in an interview of her and other county epidemiologists' research results.

The researchers found that at multiple bureaucratic steps in the death process, there is no consistent way to identify if someone is transgender or nonbinary. And they found that for 47 Portland area people identified as transgender or nonbinary in the detailed reports produced after a death investigation from 2011-2021, 29 were misgendered in the official record.

"If you extrapolate that to the national level, we are significantly and very seriously undercounting deaths in our transgender persons," Repp said, with the likely consequence that health officials don't know the scale of fatal violence transgender people are subjected to.

Most case management software doesn't have a field for gender identity, the researchers said, which is a problem if someone's s*x at birth doesn't match their gender. They also found that next-of-kin dictate the s*x listed on a person's death certificate, which is a problem if they aren't aware of or disagree with the person's identity.

To address the problem, the researchers made several recommendations. They suggested that gender identity be trackable in the software officials use to track deaths and be a federally mandated field in death certificates. They also suggested that death investigators be trained in how and why to track gender identity.

"From the data standpoint, this is a simple problem to fix," Clackamas County epidemiologist Molly Mew said in a statement. "The systems just need more inclusive boxes."