Over 20 million adverse events, 30,000 deaths, and 6% of all disability adjusted life years in the US in 1998 were attributable to sexual behaviour, according to a study published in the February edition of Sexually Transmitted Infections. The investigators note that nearly all adverse health events related to sexual behaviour were preventable and note that sexual health testing and treatment, hepatitis B vaccination, correct and consistent condom and contraceptive use, cervical smears, and delaying the age of first sexual experience could substantially reduce the public health burden related to sexual behaviour.
US investigators assessed that over half of all US deaths in 1990 could be attributed to one of nine causes, and that sexual behaviour was responsible for 30,000 deaths. Measuring death alone, however, does not allow a proper understanding of the adverse outcomes which could be attributed to sexual behaviour. Accordingly, investigators estimated the incidence of adverse health events including illness, death, and disability caused by sexual behaviour. The impact of disability was calculated by determining disability adjusted life years attributable to sexual behaviour, taking into account both life years lost due to premature death, and loss of healthy life.
The investigators included all major sexually transmitted infections in their analysis. They also included the proportion of HIV and hepatitis B virus cases which epidemiological studies suggested could be attributed to sexual behaviour. All elective abortions which were not medically indicated were included in the investigators’ model.
Results
In 1998, 20 million adverse health events (7500 per 1000,000 people), just under 30,000 deaths (1% of all US deaths) were attributable to sexual behaviour, contributing 2,160, 000 disability adjusted life years (6% of all US disability adjusted life years).
Most sexual behaviour adverse events (62%) and disability adjusted life years (57%) affected women, but most deaths (66%) occurred in men. However, if HIV mortality was excluded 80% of all deaths attributable to sexual behaviour occurred in women.
Over 840,000 (of a total of 1,224,00) disability adjusted life years in women were contributed by curable sexually transmitted infections.
Viral infections caused the overwhelming majority of deaths (99% in men and 97% in women). Amongst men, HIV caused 18,200 of 19,600 deaths caused by sexually transmitted viruses. Sexually acquired hepatitis B virus killed 711 men, and sexually transmitted hepatitis C virus killed 612 men. No deaths in men were attributed to HPV and anal cancer. Amongst women HPV and cervical cancer caused a little under 5,000 of the 10,000 total deaths caused by sexually transmitted viruses with HIV causing a little over 4,200 deaths.
It is worth noting, however, that 210 women and 90 men died as a consequence of bacterial sexually transmitted infections which could, with appropriate treatment have been completely cured.
“Our findings highlight the extent and range of adverse effects of sexual behaviour”, write the investigators. They also note, “interventions among adolescents to delay age of first sexual contact, widespread [HPV] testing and the use of hepatitis B vaccine, screening and treatment of curable STIs, and correct and consistent use of condoms and contraceptives can reduce the sexual behaviour related public health burden substantially.”
The investigators conclude, “nearly all sexual behaviour related adverse health events are preventable.”
Ebrahim SH et al. Sexual behaviour: related adverse health burdens in the United States. Sex Transm Infect: 81: 38 – 40, 2005.