Chichetto Natalie E, Canidate Shantrel, Gebru Nioud M, McNeely Kayla V, Ding Delaney D, Hanna David B, Parikh Zalak, Shoptaw Steven J, Jones Deborah L, Lazar Jason M, Kizer Jorge R, Cohen Mardge H, Haberlen Sabina A, Lahiri Cecile D, Wise Jenni M, Palella Frank, Levine Andrew, Friedman M Reuel, Plankey Michael
Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA.
School of Public Health, Brown University, 121 S Main St, Providence, RI 02903, USA.
Drug Alcohol Depend. 2025 Jan 1;266:112523. doi: 10.1016/j.drugalcdep.2024.112523. Epub 2024 Dec 9.
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.
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.
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.
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、吸烟和抑郁在男男性行为者（MSM）中很常见。运用共病框架（即两种或更多状况相互作用导致不良健康结果），对这些状况的共现纵向模式与MSM死亡率之间的关联进行了测试。
分析了1999年至2018年来自多中心艾滋病队列研究中3046名MSM的纵向数据。建立了酒精使用、吸烟和抑郁症状的基于组的轨迹模型（GBTM）。基于每种状况（即酗酒、当前吸烟、严重抑郁症状）在GBTM中的重叠高危组成员身份定义共病表型。Cox比例风险模型估计了共病表型与死亡率（国家死亡指数，n = 395；中位随访16.0年）的混杂因素调整关联。测试了HIV与共病表型在死亡率上的相互作用。
共病表型包括无高危状况（63%）、仅酗酒（3%）、仅吸烟（16%）、仅抑郁症状（10%）以及两种或更多高危轨迹（9%，持续共病）。在MSM中，与无状况（风险比[HR] 4.48，95%置信区间[CI] 3.21，6.26）或任何单一状况（酗酒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，共病与更高的死亡风险相关。共病表型与HIV在死亡风险上的相互作用显著。
近10%的MSM出现了高危饮酒、吸烟和抑郁症状的长期聚集，且与死亡风险增加相关，尤其是在感染HIV的MSM中。
