Substance use disorders and related hospitalizations and mortality among gay, bisexual, and other men who have sex with men: A matched cohort study.

Abstract

Gay, bisexual, and other men who have sex with men (GBM), especially those living with HIV, may face greater substance-related harms. We compared substance use disorder (SUD) diagnoses, SUD-related hospitalizations, and all-cause mortality between GBM and men from the general population in Metro Vancouver. We also explored factors associated with these outcomes among GBM. We linked 798 consenting participants from two GBM cohorts (Momentum and Engage) to administrative health data and matched them (1:5) on age, sex, and geography to 3990 HIV-negative British Columbia residents. We calculated incidence rate ratios [IRR] for the three outcomes. We used multivariable regression to examine factors associated with SUD diagnoses and SUD-related hospitalizations among GBM. Compared to men from the general population, GBM had higher rates of SUD diagnoses (IRR=2.73; 95% confidence interval [CI]=2.00-3.73) and SUD-related hospitalizations (IRR=1.97; 95% CI=1.21-3.20), but similar all-cause mortality (IRR=1.03; 95% CI=0.55-1.91). Substance-related deaths were rare (n = 7; all in the matches). Among GBM, SUD diagnoses were associated positively with living with HIV (adjusted IRR [aIRR]=2.95; 95% CI=1.68, 5.17) and recent transactional sex (aIRR=3.71; 95% CI=1.88, 7.33), and negatively with stable housing (aIRR=0.41; 95% CI=0.19, 0.91). SUD-related hospitalizations were associated positively with living with HIV (aIRR=3.10; 95% CI=1.46, 6.56) and recent tobacco use (aIRR=2.42; 95% CI=1.40, 4.17), and negatively with current employment (IRR=0.49; 95% CI=0.26, 0.91) and stable housing (aIRR=0.35; 95% CI=0.20, 0.64). GBM experienced higher rates of SUD diagnoses and SUD-related hospitalizations. Public health and mental health interventions and policies should respond to GBM's challenges.