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Deaths from smoking and from HIV/AIDS among gay and bisexual men in California, 2005–2050
  1. Wendy B Max1,
  2. Brad B Stark1,
  3. Hai-Yen Sung1,
  4. Naphtali B Offen2
  1. 1 Institute for Health and Aging, University of California, San Francisco, San Francisco, California, USA
  2. 2 San Francisco, California, USA
  1. Correspondence to Professor Wendy B Max, Institute for Health and Aging, University of California, San Francisco, San Francisco, CA 94118, USA; wendy.max{at}


Introduction Deaths from HIV/AIDS have long been of concern to the gay community, but less attention has focused on smoking-attributable deaths despite the relatively high smoking rates among gay and bisexual men. This study compared deaths from HIV/AIDS with smoking-attributable deaths among California gay and bisexual men from 2005 to 2050.

Methods Smoking-attributable fractions (SAFs) were estimated using smoking prevalence for gay and bisexual men from the 2011–2014 California Health Interview Surveys and published relative risks of death. Smoking-attributable deaths were calculated by multiplying the SAFs by deaths among gay and bisexual men. Deaths from HIV/AIDS among men who have sex with men was obtained from the California Department of Public Health. Future deaths from smoking and HIV/AIDS were projected using regression equations based on time trends.

Results From 2005 to 2014, smoking caused over 6800 deaths among gay and bisexual men, while nearly 9500 died from HIV/AIDS. Mortality from both causes has been falling, but deaths from HIV/AIDS have been falling more rapidly. Projections suggest that in the mid-2040s, more gay/bisexual men will die from smoking than from HIV/AIDS.

Conclusion Smoking will surpass HIV/AIDS as a cause of death among gay and bisexual men in California within a few decades. The lesbian, gay, bisexual and transgender (LGBT) community was highly effective in drawing attention and resources to the fight against HIV/AIDS, saving untold lives by hastening effective treatments. Lessons learnt in the fight against AIDS should be used to help fight the tobacco epidemic.

  • priority/special populations
  • advocacy
  • disparities

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  • Contributors WBM obtained the funding, directed all aspects of the research and drafted the manuscript. BBS helped conceptualise the models and conducted the analyses. NBO conceived of the research question, helped interpret the findings and helped draft the manuscript. H-YS helped develop the analyses and interpret the findings. All authors revised and reviewed the final manuscript.

  • Funding This research was funded by the California Tobacco-Related Disease Research Program, Grant #22RT-0120

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data may be obtained from a third party and are not publicly available.