Transvestites and transgender women (TMTs) in Brazil face social exclusion, violence, and invisibility, with poorly documented morbidity and mortality patterns. This study analyzed mortality and identified factors associated with death among TMTs in Rio de Janeiro, Brazil, from 2015 to 2024.

Survival analysis was performed using probabilistic linkage between two databases: Transcendendo, a prospective cohort conducted since 2015 at the Evandro Chagas National Institute of Infectious Diseases (INI-Fiocruz), and the Mortality Information System. TMTs aged 18 or older, living with or without HIV, enrolled between 2015 and 2024 were included. Kaplan-Meier curves were used to estimate cumulative survival probabilities over time and compare groups via the log-rank test. The Cox proportional hazards model identified factors independently associated with mortality.

Of 961 TMTs included during the period, 626 were eligible for analysis. Median age was 31.6 years (interquartile range [IQR]: 25.3–39.5); 43.9% were mixed race and 28.3% Black; 66.3% had ≤ 12 years of education; and 63.4% were living with HIV. Fifty-six deaths were identified (45 among those living with HIV and 11 among HIV-negative participants). Unstable housing (hazard ratio [HR] = 3.0 [95% confidence interval (CI): 2.1–4.4]; p < 0.001), HIV-positive status (HR = 2.1 [95% CI: 1.4–3.2]; p = 0.003), and age > 35 years (HR = 1.8 [95% CI: 1.1–2.9]; p = 0.045) were associated with a higher risk of death.

The results highlight the role of HIV infection and sociodemographic factors, such as housing instability and older age, in the mortality of TMTs, underscoring the urgent need for broader public health policies to reduce inequities in this population.