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

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

doi:10.1016/j.drugalcdep.2024.112523

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

Drug Alcohol Depend. 2024 Dec 9:266:112523. doi: 10.1016/j.drugalcdep.2024.112523. Online ahead of print.

Authors

Natalie E Chichetto¹, Shantrel Canidate², Nioud M Gebru³, Kayla V McNeely⁴, Delaney D Ding⁵, David B Hanna⁶, Zalak Parikh⁷, Steven J Shoptaw⁸, Deborah L Jones⁹, Jason M Lazar¹⁰, Jorge R Kizer¹¹, Mardge H Cohen¹², Sabina A Haberlen¹³, Cecile D Lahiri¹⁴, Jenni M Wise¹⁵, Frank Palella¹⁶, Andrew Levine¹⁷, M Reuel Friedman¹⁸, Michael Plankey¹⁹

Affiliations

¹ Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA. Electronic address: nchichetto@ufl.edu.
² Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA. Electronic address: ssc1987@ufl.edu.
³ School of Public Health, Brown University, 121 S Main St, Providence, RI 02903, USA. Electronic address: neo_gebru@brown.edu.
⁴ Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA. Electronic address: kaylamcneely@ufl.edu.
⁵ Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA. Electronic address: delaney.ding@ufl.edu.
⁶ Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York 10461, USA. Electronic address: david.hanna@einsteinmed.edu.
⁷ Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York 10461, USA. Electronic address: zalak.parikh@einsteinmed.edu.
⁸ Department of Family Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA. Electronic address: SShoptaw@mednet.ucla.edu.
⁹ Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL 33136, USA. Electronic address: d.jones3@med.miami.edu.
¹⁰ Department of Medicine, The State University of New York -Downstate Medical Center, 450 Clarkson Ave Suite J, Brooklyn, New York 11203, USA. Electronic address: jason.lazar@downstate.edu.
¹¹ Department of Epidemiology & Population Health, San Francisco Veterans Affairs Health Care System, University of California, 4150 Clement St, San Francisco, CA 9412, USA. Electronic address: jorge.kizer@ucsf.edu.
¹² Stroger Hospital/Cook County Health and Hospitals System, 1969 W Ogden Ave, Chicago, IL 60612, USA.
¹³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. Electronic address: shaberlen@jhu.edu.
¹⁴ Department of Medicine, Division of Infectious Diseases, Emory University, Medical Office Tower, 550 Peachtree St NE Fl 7, Atlanta, GA 30308, USA. Electronic address: cdelill@emory.edu.
¹⁵ School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, Birmingham, AL 35294, USA. Electronic address: jmwise@uab.edu.
¹⁶ Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: f-palella@northwestern.edu.
¹⁷ Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA. Electronic address: ajlevine@mednet.ucla.edu.
¹⁸ Department of Urban-Global Public Health, Rutgers School of Public Health, 683 Hoes Ln W, Piscataway, NJ 08854 USA. Electronic address: mf1061@sph.rutgers.edu.
¹⁹ School of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd NW, Washington, DC 20007, USA. Electronic address: mwp23@georgetown.edu.

PMID: 39662355
DOI: 10.1016/j.drugalcdep.2024.112523

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.

Keywords: Alcohol; Depression; HIV; MSM; Mortality; Smoking; Syndemic; Trajectory.