Population-level research suggests nearly all of us have something we could work on

TORONTO, July 04, 2023 – A new long-term study of population-level data shows that when it comes to health, pretty much everyone could make improvements, plus the relationship with risk factors and mortality changes over time, sometimes in surprising ways.

“You can take this as a good news story or a bad news story, depending on how you want to look at these numbers,” says Faculty of Health Associate Professor with the School of Kinesiology and Health Science , lead author of the study. “What we discovered is that the relationship with risk factors and mortality changes over time, which could be explained by factors such as evolution in treatments and changes in social stigma. Overall, most of us have something wrong with us, and we’re more likely to have a lifestyle health-risk factor now than in the ’80s and that’s actually associated with even greater mortality risk now than before.”

The research,, took United States survey data from 1988 to 1994 and 1999 to 2014, and looked at the five-year mortality odds for people 20 or older. The research team looked at 19 different risk factors and then adjusted the data for age, sex, obesity category and ethnicity. What they found overall was that less than three per cent of people had none of the risk factors. While previous research has documented the risk factors very well, Kuk says what was less understood was the relationship between various risks and the likelihood for mortality over time. Kuk and the research team found that that relationship could sometimes be paradoxical.

For example, says Kuk, rates of smoking, long linked to conditions that can lead to death such as cancer, heart disease, stroke and diabetes, have overall decreased thanks to strong public-health campaigns. However, the overall risk of being a smoker increased over time, which Kuk says could perhaps be explained by increased stigma as the addiction became less common and awareness of risks grew, which may also be reflected in research funding.

“If you look at cancer research, there's a lot of funding overall, but specifically for lung cancer, it seems to be associated with moral fault and as a consequence lower funding,” says Kuk. “When you look at the mortality risk associated with having lung cancer relative to all the other common cancers, it's extremely high. So I think that this lack of push is detrimental.”

Kuk’s main area of research is obesity, and here she found that while the prevalence has gone up, the risks have gone down.

“Even though there's more and more people with obesity, it's actually not resulting in more deaths over time. And so I think that that's another clear thing we need to recognize, that we're very good at treating the outcomes associated with obesity. And regardless of what our body weight is, most of us have something that we can probably work on.”

Some of the other health trends that Kuk found in the data include:

• Diabetes and hypertension rates have gone up over time, but risks have gone down.
• More people aren’t exercising, and this is now related to worse outcomes than it once was.
• Being on mental-health medications was not a significant risk factor in the 1980s, but in the later dataset was associated with increased mortality.
• Not finishing high school is associated with health risks, while it was not in the 1980s.

While Kuk says the research points to nearly all of us having room for improvement when it comes to various factors like diet, exercise, smoking, alcohol and drug intake, she also says that there are factors that are out of many people’s individual control.

“When we look at things like food insecurity, low education — as a society, we're making it so that health might not be an easy choice for a lot of people. We need to be sensitive to that when we take a look at these risk factors.”

of Jennifer Kuk explain the research.

About 91��ɫ

91��ɫ is a modern, multi-campus, urban university located in Toronto, Ontario. Backed by a diverse group of students, faculty, staff, alumni and partners, we bring a uniquely global perspective to help solve societal challenges, drive positive change, and prepare our students for success. 91��ɫ’s fully bilingual Glendon Campus is home to Southern Ontario’s Centre of Excellence for French Language and Bilingual Postsecondary Education. 91��ɫ’s campuses in Costa Rica and India offer students exceptional transnational learning opportunities and innovative programs. Together, we can make things right for our communities, our planet, and our future.

Media Contacts: Emina Gamulin, 91��ɫ Media Relations and External Communications, 437-217-6362, egamulin@yorku.ca

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Toronto, ON, June 7, 2023 – Women who identify as bisexual were more than three times more likely to attempt suicide compared to heterosexual women, by a group of researchers at 91��ɫ and ICES published online today.

The research, which is the first to link population-based survey data with health records for over 123,000 individuals, also found that gay men and gay women/lesbians were twice as likely to attempt suicide, both fatal and non-fatal, which the team refers to as a suicide-related behaviour (SRB) event, compared to heterosexual individuals. The findings point to an urgent need for better mental health supports within the LGBTQ+ community.

“We wanted to better characterize the disparity in suicide-related behaviours across sexual orientations and gender,” says lead author , a Faculty of Health assistant professor and Canada Research Chair in Population Health Data Science at 91��ɫ and adjunct scientist at ICES. “Prior research on suicide attempts has mostly relied on self-reported data from surveys, which means we don’t have information on people who are too sick to participate or have died by suicide.”

Published in the , the study looked at Ontario participants from the Canadian Community Health Survey, which was linked to anonymous administrative health data such as emergency room visits or hospitalizations for non-fatal self-harm and fatal suicide events between 2002 and 2019.

The researchers, who include 91��ɫ postdoctoral fellows Gabriel John Dusing and Chungah Kim, found:

• Overall prevalence of one or more SRB events was around two per cent in heterosexual individuals, five per cent in gay/lesbian individuals, and eight per cent in bisexual individuals.
• Sexual minority individuals were at higher risk of SRB events, ranging from 2.10 to 4.23 times more likely when compared to heterosexual people.
• After adjusting for age and gender, the risk of a SRB event was more than three times greater among bisexual individuals, and this risk was most pronounced for bisexual women.

“The higher risk for bisexual women could be attributed to greater discrimination that bisexual people face within the LGBTQ+ community, as well as higher rates of violence, trauma, and caregiving burden that bisexual women may experience in opposite-sex relationships,” says Chum.

One limitation of the study is that data were not available for non-binary individuals and sexual orientations such as asexual and queer. Nevertheless, this was the first study to use a large representative sample linked with medical records, which improves the generalizability of the findings for other regions and populations.

“The study shows a clear need for better funding, policy and programming to address LGBTQ+ suicide risk,” says Chum. “We also need increased training for healthcare workers to address LGBTQ+ suicide risk. Further, we want to encourage hospitals and clinics to collect sexual orientation data as part of routine patient care.”

Chum also notes the increasing creep of healthcare privatization and that publicly funded mental health supports need to be increased not just for LGBTQ+ people, but across the board.

The findings align with the authors’ published in March in PLOS One, which found that both sexual minority status and residing in under-resourced neighbourhoods with poor access to healthcare, were independent risk factors for suicide-related behaviours. Future research needs to explore interventions that improve the mental health of LGBTQ+ people while addressing social determinants of health, such as neighbourhood-level disparities and barriers to healthcare.

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