Preventable mortality among sexual minority Canadians

Travis Salway; Ashleigh J Rich; Olivier Ferlatte; Dionne Gesink; Lori E Ross; Richard Bränström; Aida Sadr; Syma Khan; Troy Grennan; Mostafa Shokoohi; David J Brennan; Mark Gilbert

doi:10.1016/j.ssmph.2022.101276

Preventable mortality among sexual minority Canadians

SSM Popul Health. 2022 Oct 27:20:101276. doi: 10.1016/j.ssmph.2022.101276. eCollection 2022 Dec.

Authors

Travis Salway^{1

2

3}, Ashleigh J Rich⁴, Olivier Ferlatte^{5

6}, Dionne Gesink⁷, Lori E Ross⁷, Richard Bränström⁸, Aida Sadr⁹, Syma Khan¹⁰, Troy Grennan^{2

11}, Mostafa Shokoohi⁷, David J Brennan¹², Mark Gilbert^{2

13}

Affiliations

¹ Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
² British Columbia Centre for Disease Control, Vancouver, Canada.
³ Centre for Gender and Sexual Health Equity, Vancouver, Canada.
⁴ Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.
⁵ École de santé publique, Université de Montréal, Montréal, Canada.
⁶ Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.
⁷ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁸ Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
⁹ Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
¹⁰ Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
¹¹ Division of Infectious Diseases, University of British Columbia, Vancouver, Canada.
¹² Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
¹³ School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.

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.

Keywords: Mortality; Sexual and gender minorities; Social determinants of health.

Grants and funding

P2C HD050924/HD/NICHD NIH HHS/United States