Is the association between sexual minority status and suicide-related behaviours modified by rurality? A discrete-time survival analysis using longitudinal health administrative data

Andrew Nielsen; Karanpreet Kaur Azra; Chungah Kim; Gabriel John Dusing; Antony Chum

doi:10.1016/j.socscimed.2023.115896

Is the association between sexual minority status and suicide-related behaviours modified by rurality? A discrete-time survival analysis using longitudinal health administrative data

Soc Sci Med. 2023 May:325:115896. doi: 10.1016/j.socscimed.2023.115896. Epub 2023 Apr 7.

Authors

Andrew Nielsen¹, Karanpreet Kaur Azra², Chungah Kim³, Gabriel John Dusing³, Antony Chum⁴

Affiliations

¹ Canadian Institute for Health Information, 4110 Yonge St Suite 300, North York, ON M2P 2B7, Canada.
² Ontario Shores Centre for Mental Health Sciences, 700 Gordon St, Whitby, Ontario, L1N 5S9, Canada.
³ School of Kinesiology and Health Science, York University, 4700 Keele St, Toronto, Ontario, M3J 1P3, Canada.
⁴ School of Kinesiology and Health Science, York University, 4700 Keele St, Toronto, Ontario, M3J 1P3, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada; Unity Health Toronto, MAP Centre for Urban Health Solutions, 209 Victoria Street, 3rd floor, Toronto, Ontario, M5B 1T8, Canada. Electronic address: chuma@yorku.ca.

PMID: 37084702
DOI: 10.1016/j.socscimed.2023.115896

Abstract

Background: While self-reported data shows that lesbian, gay, and bisexual (LBG) individuals have a greater suicide-related behaviours (SRB) risk, little is known about how rurality may amplify SRB risk associated with sexual minority status. Sexual minority individuals in rural areas may experience unique stressors due to stigma and a lack of LGB-specific social and mental health services. Using a population-representative sample linked to clinical SRB outcomes, we examined whether rurality modifies the association between sexual minority status and SRB risk.

Methods: A nationally representative survey linked to administrative health data was used to construct a cohort of individuals (unweighted n = 169,091; weighted n = 8,778,115) in Ontario, Canada, and captured all SRB-related emergency department visits, hospitalizations, and deaths between 2007 and 2017. Sex-stratified discrete-time survival analyses were used to examine interactions between rurality and sexual minority status on SRB risk while controlling for potential confounders.

Results: Sexual minority men had 2.18 times higher SRB odds compared to their heterosexual counterparts (95%CI 1.21-3.91), while sexual minority women had 2.07 times higher odds (95%CI 1.48-2.89) after adjusting for the confounders. The Rurality Index of Ontario and the Index of Remoteness were associated with the odds of SRB in a dose-response manner. No significant interactions were observed between rural and sexual minority status.

Conclusions: Our study provides evidence that rural and sexual minority status both independently contribute to an elevated likelihood of SRB; however, rurality did not appear to modify SRB risk by sexual orientation. Implementation and evaluation of interventions to reduce SRB in both rural and sexual minority populations are required.

Keywords: Bisexual; Canada; Gay; LGB; Lesbian; Ontario; Rurality; Suicide.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bisexuality / psychology
Female
Humans
Male
Ontario / epidemiology
Routinely Collected Health Data*
Sexual Behavior
Sexual and Gender Minorities*
Suicidal Ideation

Grants and funding

165892/CIHR/Canada