Background Because men who have sex with men (MSM) are not identifiable at a population level, there are few data on cause-specific mortality rates among MSM. MSM are more likely to report suicide attempts than heterosexuals, but it is not known if suicide mortality is higher among MSM. Likewise, although anal cancer is more common among MSM than among heterosexuals, the absolute risk of anal cancer death among MSM is not known. We compared suicide and anal cancer mortality rates among MSM and heterosexual males and females in an STD clinic population.
Methods We enumerated all Public Health-Seattle and King County STD Clinic attendees from 1993-2007 (n=86,807). Using 1993−2008 mortality data from Washington State (n=702 850), we identified STD clinic attendees who had died and their underlying cause of death. We calculated suicide and anal cancer mortality rates for MSM, heterosexual men, and women, and standardised these rates using the age, race, and gender distribution of King County residents (US Census, 2000). We calculated adjusted incidence rate ratios (IRR) among STD clinic attendees using Poisson regression. To compare mortality rates among STD clinic attendees to the general population, we calculated rates in King County.
Results Among STD clinic attendees, 14% were MSM, 52% were heterosexual men, and 34% were women. For the period between 1993 and 2008, we matched 1901 Washington state deaths to STD clinic attendees for an overall unadjusted mortality rate of 1.8 deaths per 1000 person-years. The standardised suicide mortality rate among MSM was 0.20 per 1000 person-years, compared with 0.11 among heterosexual men and 0.09 among all women. Adjusted for age and race, among STD clinic attendees, MSM were 1.6 times more likely to die from suicide than heterosexual men (IRRadj=1.6, 95% CI 1.02 to 2.61) and nearly four times more likely than women (IRRadj=3.9, 95% CI 2.14 to 7.24. The suicide mortality rate among MSM in the STD clinic was higher than the rate among all men in King County (standardised rate ratio=1.5), adjusted for age and race. We identified no deaths due to anal cancer in any subpopulation (95% CI 0 to 0.4 per 100 000 person-years).
Conclusions These data suggest that, at least among STD clinic attendees, MSM are approximately twice as likely to die from suicide as heterosexual men, and these rates are higher than the general population. Anal cancer death rates among King County MSM appear to be low.