Disparities in alcohol- and substance-related hospitalizations and deaths across sexual orientations in Canada: a longitudinal study

Abstract

ObjectivesWe aim to quantify disparities in substance-related acute events (i.e. hospitalizations and deaths for substances, including alcohol, cannabis, opioids, narcotics, and/or illicit drugs) across sexual orientations based on health administrative data. Study designThis was a longitudinal analysis from six waves of the Canadian Community Health Survey (2009–2014) linked to hospitalization/mortality data in Ontario, Canada. MethodsThe study sample consisted of survey respondents aged ≥15 (weighted n = 15,406,000) who provided a valid response to the question about sexual orientation. The primary outcome was substance-related acute events, including hospitalizations and deaths due to alcohol, cannabis, opioids, narcotics, and/or illicit drugs. Disparities in substance-related acute events across sexual orientation and gender were examined using flexible parametric survival analysis. ResultsBisexual women had hazard ratios of 2.46 (95% confidence interval: 1.46–4.15) for any substance-related acute event and 2.67 (95% confidence interval: 1.42–5.00) for non-alcohol substance acute events compared to heterosexual women. Lesbian women did not exhibit significant differences in acute event risk compared to heterosexual women. Gay and bisexual men demonstrated elevated but not statistically significant risks compared to heterosexual men. ConclusionsBisexual women face higher risks of substance-related acute events, potentially due to self-medication of unique stressors brought on by discrimination and isolation. Enhanced education and training for healthcare professionals are essential to increase awareness and sensitivity toward the heightened substance use risk among lesbian, gay, and bisexual individuals. Targeted interventions aimed at reducing substance use problems among bisexual individuals warrant increased funding and research.