Impact of syndemic heavy drinking, smoking, and depression on mortality among MSM with and without HIV: A longitudinal study

IF 3.9 2区 医学 Q1 PSYCHIATRY
Natalie E. Chichetto , Shantrel Canidate , Nioud M. Gebru , Kayla V. McNeely , Delaney D. Ding , David B. Hanna , Zalak Parikh , Steven J. Shoptaw , Deborah L. Jones , Jason M. Lazar , Jorge R. Kizer , Mardge H. Cohen , Sabina A. Haberlen , Cecile D. Lahiri , Jenni M. Wise , Frank Palella , Andrew Levine , M. Reuel Friedman , Michael Plankey
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引用次数: 0

Abstract

Background

Heavy drinking, smoking, and depression are common among men who have sex with men (MSM). The association of co-occurring longitudinal patterns of these conditions and mortality among MSM were tested, applying a syndemic framework – the interaction of two or more conditions that contribute to poor health outcomes.

Methods

Longitudinal data from 1999 to 2018 from the Multicenter AIDS Cohort Study of 3046 MSM were analyzed. Group-based trajectories models (GBTM) of alcohol use, smoking, and depressive symptoms were developed. Syndemic phenotypes were defined based on overlapping high-risk group membership in the GBTM for each condition (i.e., heavy drinking, current smoking, severe depressive symptoms). Cox proportional hazards models estimated confounder-adjusted associations of syndemic phenotypes with mortality (National Death Index, n = 395; median follow-up 16.0 years). An interaction between HIV and syndemic phenotypes on mortality was tested.

Results

Syndemic phenotypes included no high-risk conditions (63 %), heavy drinking only (3 %), smoking only (16 %), depressive symptoms only (10 %), and two or more high-risk trajectories (9 %, sustained syndemic). Among MSM, the syndemic was associated with greater mortality risk compared to no conditions (hazard ratio [HR] 4.48, 95 % confidence interval [CI] 3.21, 6.26) or any single condition (heavy drinking HR 1.84, CI 0.90, 3.75; smoking HR 2.70, CI 2.03, 3.59; depression HR 2.31, CI 1.69, 3.14). The interaction between syndemic phenotype and HIV on mortality risk was significant.

Conclusions

The long-term clustering of high-risk drinking, smoking, and depressive symptoms occurred in nearly 10 % of MSM and was associated with increased mortality risk, especially among MSM living with HIV.
酗酒、吸烟和抑郁对感染和不感染艾滋病毒的男同性恋者死亡率的影响:一项纵向研究。
背景:酗酒、吸烟和抑郁在男男性行为者(MSM)中很常见。采用综合症框架--两种或两种以上导致不良健康后果的病症相互作用--对这些病症的共存纵向模式与 MSM 死亡率之间的关联进行了测试:分析了多中心艾滋病队列研究(Multicenter AIDS Cohort Study)中 3046 名 MSM 从 1999 年到 2018 年的纵向数据。建立了基于群体的饮酒、吸烟和抑郁症状轨迹模型(GBTM)。根据每种情况(即大量饮酒、当前吸烟、严重抑郁症状)在 GBTM 中重叠的高危群体成员身份定义了综合症表型。Cox 比例危险模型估计了经混杂因素调整后的综合征表型与死亡率的关系(全国死亡指数,n = 395;中位数随访 16.0 年)。测试了艾滋病毒和综合征表型对死亡率的交互作用:综合征表型包括无高危情况(63%)、仅酗酒(3%)、仅吸烟(16%)、仅抑郁症状(10%)以及两种或两种以上高危轨迹(9%,持续综合征)。在 MSM 中,与无条件(危险比 [HR] 4.48,95% 置信区间 [CI] 3.21,6.26)或任何单一条件(大量饮酒 HR 1.84,CI 0.90,3.75;吸烟 HR 2.70,CI 2.03,3.59;抑郁 HR 2.31,CI 1.69,3.14)相比,综合征与更高的死亡风险相关。综合征表型和艾滋病毒对死亡风险的交互作用是显著的:结论:近 10% 的 MSM 存在高危饮酒、吸烟和抑郁症状的长期聚集现象,这与死亡风险的增加有关,尤其是在感染 HIV 的 MSM 中。
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来源期刊
Drug and alcohol dependence
Drug and alcohol dependence 医学-精神病学
CiteScore
7.40
自引率
7.10%
发文量
409
审稿时长
41 days
期刊介绍: Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.
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