Citation

Salway T, Rich AJ, Ferlatte O, Gesink D, Ross LE, Bränström R, Sadr A, Khan S, Grennan T, Shokoohi M, Brennan DJ, Gilbert M. SSM Popul. Health 2022; 20.

Copyright

(Copyright © 2022, Elsevier Publishing)

DOI

10.1016/j.ssmph.2022.101276

PMID

unavailable

Abstract

BACKGROUND: Epidemiologic studies point to multiple health inequities among sexual minority people, but few studies have examined mortality. Some causes of death are more preventable than others, and access to prevention is theorized to follow patterns of access to social and material resources. The objective of this study is to compare estimates of preventable mortality between sexual minority (SM)--i.e., bisexual, lesbian, gay--and heterosexual adults in Canada.

METHODS: A population-based retrospective cohort with 442,260 (unweighted N) Canadian adults, ages 18-59 years, was drawn from the Canadian Community Health Survey/Canadian Mortality Database linked database (2003-2017). The Rutstein preventability rating index was used to classify cause-specific mortality (low/high). Longitudinal analyses were conducted using Cox proportional hazards models.

RESULTS: SM respondents had higher hazard of all-cause mortality (unadjusted hazard ratio [uHR] 1.28, 95% CI 1.06, 1.55). The uHR increased when the outcome was limited to highly-preventable causes of mortality (uHR 1.43, 95% CI 1.14, 1.80). The uHR further increased in sensitivity analyses using higher thresholds of the Rutstein index. SM respondents had higher hazard of cause-specific mortality for heart disease (uHR 1.53, 95% CI 1.03, 2.29), accidents (uHR 1.97, 95% CI 1.01, 3.86), HIV (uHR 75.69, 95% CI 18.77, 305.20), and suicide (uHR 2.22, 95% CI 0.93, 5.30) but not for cancer (uHR 0.86, 95% CI 0.60, 1.25). The adjusted HR (aHR) for highly-preventable mortality was not attenuated by adjustment for confounders (aHR 1.57, 95% CI 1.20, 2.05) but was reduced by adjustment for hypothesized mediators relating to access to social and material resources (marital status, children, income, education; aHR 1.11, 95% CI 0.78, 1.58).

CONCLUSIONS: Preventable mortality was elevated for SM Canadians compared to heterosexuals. Early and broad access to sexual minority-affirming primary and preventive healthcare should be expanded. © 2022 The Authors

Language: en

Keywords

adult; human; Mortality; female; male; public health; cause of death; physical activity; education; hospitalization; comparative study; major clinical study; heterosexuality; sexual orientation; controlled study; retrospective study; health care delivery; marriage; bisexuality; middle aged; health survey; social status; cohort analysis; sensitivity analysis; sample size; ICD-10; Human immunodeficiency virus; income distribution; Article; hazard ratio; Social determinants of health; health disparity; Canadian; social determinants of health; premature mortality; household income; homosexual female; all cause mortality; sexual and gender minority; Sexual and gender minorities; acute HIV infection