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Same-sex marriage, autoimmune thyroid gland dysfunction and other autoimmune diseases in Denmark 1989–2008

Abstract

Autoimmune diseases have been little studied in gay men and lesbians. We followed 4.4 million Danes, including 9,615 same-sex married (SSM) persons, for 47 autoimmune diseases in the National Patient Registry between 1989 and 2008. Poisson regression analyses provided first hospitalization rate ratios (RRs) comparing rates between SSM individuals and persons in other marital status categories. SSM individuals experienced no unusual overall risk of autoimmune diseases. However, the risk of autoimmune thyroid dysfunction was increased, notably Hashimoto’s thyroiditis (womenSSM, RR = 2.92; 95 % confidence interval (CI) 1.74–4.55) and Graves’ disease (menSSM, RR = 1.88; 95 % CI 1.08–3.01). There was also an excess of primary biliary cirrhosis (womenSSM, RR = 4.09; 95 % CI 1.01–10.7), and of psoriasis (menSSM, RR = 2.48; 95 % CI 1.77–3.36), rheumatic fever (menSSM, RR = 7.55; 95 % CI 1.87–19.8), myasthenia gravis (menSSM, RR = 5.51; 95 % CI 1.36–14.4), localized scleroderma (menSSM, RR = 7.16; 95 % CI 1.18–22.6) and pemphigoid (menSSM, RR = 6.56; 95 % CI 1.08–20.6), while Dupuytren’s contracture was reduced (menSSM, RR = 0.64; 95 % CI 0.39–0.99). The excess of psoriasis was restricted to same-sex married men with HIV/AIDS (menSSM, RR = 10.5; 95 % CI 6.44–15.9), whereas Graves’ disease occurred in excess only among same-sex married men without HIV/AIDS (menSSM, RR = 1.99; 95 % CI 1.12–3.22). Lesbians and immunologically competent gay men in same-sex marriage face no unusual overall risk of autoimmune diseases. However, the observed increased risk of thyroid dysfunction in these lesbians and gay men deserves further study.

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References

  1. 1.

    Institute of Medicine (IOM). Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The health of lesbian, gay, bisexual, and transgender people—building a foundation for better understanding. 1–367. 2011. http://www.nap.edu/catalog.php?record_id=13128. Accessed 15 Nov 2013.

  2. 2.

    Sell RL, Becker JB. Sexual orientation data collection and progress toward Healthy People 2010. Am J Public Health. 2001;91(6):876–82.

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Case P, Austin SB, Hunter DJ, et al. Sexual orientation, health risk factors, and physical functioning in the Nurses’ Health Study II. J Womens Health (Larchmt). 2004;13(9):1033–47.

    Article  Google Scholar 

  4. 4.

    Frisch M, Smith E, Grulich A, et al. Cancer in a population-based cohort of men and women in registered homosexual partnerships. Am J Epidemiol. 2003;157(11):966–72.

    PubMed  Article  Google Scholar 

  5. 5.

    Mathy RM, Cochran SD, Olsen J, et al. The association between relationship markers of sexual orientation and suicide: Denmark, 1990-2001. Soc Psychiatry Psychiatr Epidemiol. 2011;46(2):111–7.

    PubMed Central  PubMed  Article  Google Scholar 

  6. 6.

    Conron KJ, Mimiaga MJ, Landers SJ. A population-based study of sexual orientation identity and gender differences in adult health. Am J Public Health. 2010;100(10):1953–60.

    PubMed  Article  Google Scholar 

  7. 7.

    Frisch M, Brønnum-Hansen H. Mortality among men and women in same-sex marriage: a national cohort study of 8333 Danes. Am J Public Health. 2009;99(1):133–7.

    PubMed  Article  Google Scholar 

  8. 8.

    Frisell T, Lichtenstein P, Rahman Q, et al. Psychiatric morbidity associated with same-sex sexual behaviour: influence of minority stress and familial factors. Psychol Med. 2010;40(2):315–24.

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Russell ST, Joyner K. Adolescent sexual orientation and suicide risk: evidence from a national study. Am J Public Health. 2001;91(8):1276–81.

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Boehmer U, Bowen DJ, Bauer GR. Overweight and obesity in sexual-minority women: evidence from population-based data. Am J Public Health. 2007;97(6):1134–40.

    PubMed  Article  Google Scholar 

  11. 11.

    Frisch M, Biggar RJ, Engels EA, et al. Association of cancer with AIDS-related immunosuppression in adults. J Am Med Assoc. 2001;285(13):1736–45.

    CAS  Article  Google Scholar 

  12. 12.

    Frisch M, Glimelius B, van den Brule AJ, et al. Sexually transmitted infection as a cause of anal cancer. N Engl J Med. 1997;337(19):1350–8.

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Frank L. Epidemiology. When an entire country is a cohort. Science. 2000;287(5462):2398–9.

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Pedersen CB. The Danish civil registration system. Scand J Public Health. 2011;39(7 Suppl):22–5.

    PubMed  Article  Google Scholar 

  15. 15.

    Anonymous. Act No. 372 of 7 June 1989 on registered partnerships. Annu Rev Popul Law 1989;16:56.

  16. 16.

    Anonymous. Lov om ændring af lov om ægteskabs indgåelse og opløsning, lov om ægteskabets retsvirkninger og retsplejeloven og om ophævelse af lov om registreret partnerskab (in Danish), 2012 https://www.retsinformation.dk/Forms/R0710.aspx?id=142282. Accessed 15 Nov 2013.

  17. 17.

    Lynge E, Sandegaard JL, Rebolj M. The Danish National Patient Register. Scand J Public Health. 2011;39(7 Suppl):30–3.

    PubMed  Article  Google Scholar 

  18. 18.

    Pedersen M, Klarlund M, Jacobsen S, et al. Validity of rheumatoid arthritis diagnoses in the Danish National Patient Registry. Eur J Epidemiol. 2004;19(12):1097–103.

    PubMed  Article  Google Scholar 

  19. 19.

    Nielsen NM, Frisch M, Rostgaard K, et al. Autoimmune diseases in patients with multiple sclerosis and their first-degree relatives: a nationwide cohort study in Denmark. Mult Scler. 2008;14(6):823–9.

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Nielsen NM, Jørgensen KT, Pedersen BV, et al. The co-occurrence of endometriosis with multiple sclerosis, systemic lupus erythematosus and Sjogren syndrome. Hum Reprod. 2011;26(6):1555–9.

    PubMed  Article  Google Scholar 

  21. 21.

    Jørgensen KT, Pedersen BV, Nielsen NM, et al. Childbirths and risk of female predominant and other autoimmune diseases in a population-based Danish cohort. J Autoimmunity. 2012;38(2–3):J81–7.

    Article  Google Scholar 

  22. 22.

    Bager P, Simonsen J, Nielsen NM, et al. Cesarean section and offspring’s risk of inflammatory bowel disease: a national cohort study. Inflamm Bowel Dis. 2012;18(5):857–62.

    PubMed  Article  Google Scholar 

  23. 23.

    Bache I, Nielsen NM, Rostgaard K, et al. Autoimmune diseases in a Danish cohort of 4,866 carriers of constitutional structural chromosomal rearrangements. Arthritis Rheum. 2007;56(7):2402–9.

    CAS  PubMed  Article  Google Scholar 

  24. 24.

    Jørgensen KT, Rostgaard K, Bache I, et al. Autoimmune diseases in women with Turner’s syndrome. Arthritis Rheum. 2010;62(3):658–66.

    PubMed  Article  Google Scholar 

  25. 25.

    Jørgensen KT, Nielsen NM, Pedersen BV, et al. Hyperemesis, gestational hypertensive disorders, pregnancy losses and risk of autoimmune diseases in a Danish population-based cohort. J Autoimmun. 2012;38(2–3): J120–J128.

    Google Scholar 

  26. 26.

    Lipsky PE, Diamond B. Autoimmunity and autoimmune diseases. In: Braunwald E, Fauci AS, Kasper DL, et al., editors. Harrison’s principles of internal medicine. New York, NY: MacGraw-Hill; 2001. p. 1839–43.

    Google Scholar 

  27. 27.

    Haynes BF, Fauci AS. Introduction to the immune system. In: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, et al., editors. Harrison’s principles of internal medicine. New York, NY: McGraw-Hill; 1998. p. 1753–76.

    Google Scholar 

  28. 28.

    Baird KS, Alwan WH, Crossan JF, et al. T-cell-mediated response in Dupuytren’s disease. Lancet. 1993;341(8861):1622–3.

    CAS  PubMed  Article  Google Scholar 

  29. 29.

    Staines DR. Are multiple sclerosis and amyotrophic lateral sclerosis autoimmune disorders of endogenous vasoactive neuropeptides? Med Hypotheses. 2008;70(2):413–8.

    CAS  PubMed  Article  Google Scholar 

  30. 30.

    Ralph DJ, Mirakian R, Pryor JP, et al. The immunological features of Peyronie’s disease. J Urol. 1996;155(1):159–62.

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Jensen VM, Rasmussen AW. Danish education registers. Scand J Public Health. 2011;39(7 Suppl):91–4.

    PubMed  Article  Google Scholar 

  32. 32.

    Baadsgaard M, Quitzau J. Danish registers on personal income and transfer payments. Scand J Public Health. 2011;39(7 Suppl):103–5.

    PubMed  Article  Google Scholar 

  33. 33.

    Harrell FE Jr. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. New York, NY: Springer; 2001.

    Book  Google Scholar 

  34. 34.

    Carle A, Pedersen IB, Knudsen N, et al. Moderate alcohol consumption may protect against overt autoimmune hypothyroidism: a population-based case-control study. Eur J Endocrinol. 2012;167(4):483–90.

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Carle A, Pedersen IB, Knudsen N, et al. Graves’ hyperthyroidism and moderate alcohol consumption: evidence for disease prevention. Clin Endocrinol (Oxf). doi:10.1111/cen.12106.

  36. 36.

    Gransell L, Larsen H. Lige og ulige? Homoseksuelle, biseksuelle og transkønnedes levevilkår [Survey report about living conditions among Danish LGBT individuals] (in Danish). Copenhagen, CASA; 1–128. 2009 http://www.dkr.dk/sites/default/files/lige_og_ulige.pdf. Accessed 15 Nov 2013.

  37. 37.

    Corpechot C, Chretien Y, Chazouilleres O, et al. Demographic, lifestyle, medical and familial factors associated with primary biliary cirrhosis. J Hepatol. 2010;53(1):162–9.

    PubMed  Article  Google Scholar 

  38. 38.

    Smyk DS, Rigopoulou EI, Muratori L, et al. Smoking as a risk factor for autoimmune liver disease: what we can learn from primary biliary cirrhosis. Ann Hepatol. 2012;11(1):7–14.

    CAS  PubMed  Google Scholar 

  39. 39.

    Hyde Z, Comfort J, McManus A, et al. Alcohol, tobacco and illicit drug use amongst same-sex attracted women: results from the Western Australian Lesbian and Bisexual Women’s Health and Well-Being Survey. BMC Public Health. 2009;9:317.

    PubMed Central  PubMed  Article  Google Scholar 

  40. 40.

    Zaritsky E, Dibble SL. Risk factors for reproductive and breast cancers among older lesbians. J Womens Health (Larchmt). 2010;19(1):125–31.

    Article  Google Scholar 

  41. 41.

    Descatha A, Jauffret P, Chastang JF, et al. Should we consider Dupuytren’s contracture as work-related? A review and meta-analysis of an old debate. BMC Musculoskelet Disord. 2011;12:96.

    PubMed Central  PubMed  Article  Google Scholar 

  42. 42.

    Egan P, Edelman MS, Sherrill K. Findings from the Hunter College poll of lesbians, gays and bisexuals: new discoveries about identity, political attitudes, and civic engagement. New York, NY: City University of New York; 2008. p. 1–32.

    Google Scholar 

  43. 43.

    Rothblum ED, Balsam KF, Solomon SE, et al. Lesbian, gay male, bisexual, and heterosexual siblings discrepancies in income and education in three US samples. In: Badgett L, Frank J, editors. Sexual orientation discrimination: an international perspective. New York, NY: Routledge; 2007. p. 62–75.

    Google Scholar 

  44. 44.

    Weetman A. Immune reconstitution syndrome and the thyroid. Best Pract Res Clin Endocrinol Metab. 2009;23(6):693–702.

    CAS  PubMed  Article  Google Scholar 

  45. 45.

    Gilquin J, Viard JP, Jubault V, et al. Delayed occurrence of Graves’ disease after immune restoration with HAART. Highly active antiretroviral therapy. Lancet. 1998;352(9144):1907–8.

    CAS  PubMed  Article  Google Scholar 

  46. 46.

    Obel N, Reinholdt H, Omland LH, et al. Retrivability in The Danish National Hospital Registry of HIV and hepatitis B and C coinfection diagnoses of patients managed in HIV centers 1995–2004. BMC Med Res Methodol. 2008;8:25.

    PubMed Central  PubMed  Article  Google Scholar 

  47. 47.

    Blanchard R, Bogaert AF. Biodemographic comparisons of homosexual and heterosexual men in the Kinsey Interview Data. Arch Sex Behav. 1996;25(6):551–79.

    CAS  PubMed  Article  Google Scholar 

  48. 48.

    Blanchard R, Dickey R, Jones CL. Comparison of height and weight in homosexual versus nonhomosexual male gender dysphorics. Arch Sex Behav. 1995;24(5):543–54.

    CAS  PubMed  Article  Google Scholar 

  49. 49.

    Frisch M, Zdravkovic S. Body size at birth and same-sex marriage in young adulthood. Arch Sex Behav. 2010;39(1):117–23.

    PubMed  Article  Google Scholar 

  50. 50.

    Engsig FN, Hansen AB, Gerstoft J, et al. Inpatient admissions and outpatient visits in persons with and without HIV infection in Denmark, 1995–2007. AIDS. 2010;24(3):457–61.

    PubMed  Article  Google Scholar 

  51. 51.

    Morar N, Willis-Owen SA, Maurer T, et al. HIV-associated psoriasis: pathogenesis, clinical features, and management. Lancet Infect Dis. 2010;10(7):470–8.

    CAS  PubMed  Article  Google Scholar 

  52. 52.

    Nielsen GL, Sørensen HT, Pedersen AB, et al. Analyses of data quality in registries concerning diabetes mellitus—a comparison between a population based hospital discharge and an insulin prescription registry. J Med Syst. 1996;20(1):1–10.

    Google Scholar 

  53. 53.

    Fonager K, Sørensen HT, Rasmussen SN, et al. Assessment of the diagnoses of Crohn’s disease and ulcerative colitis in a Danish hospital information system. Scand J Gastroenterol. 1996;31(2):154–9.

    CAS  PubMed  Article  Google Scholar 

  54. 54.

    Mason K, Thygesen LC, Stenager E, et al. Evaluating the use and limitations of the Danish National Patient Register in register-based research using an example of multiple sclerosis. Acta Neurol Scand. 2012;125(3):213–7.

    CAS  PubMed  Article  Google Scholar 

  55. 55.

    Frisch M, Simonsen J. Marriage, cohabitation and mortality in Denmark: national cohort study of 6.5 million persons followed for up to three decades (1982–2011). Int J Epidemiol. 2013;42(2):559–78.

    PubMed  Article  Google Scholar 

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No financial support was obtained for this study.

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All authors declare that they have no conflicts of interest.

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Correspondence to Morten Frisch.

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Frisch, M., Nielsen, N.M. & Pedersen, B.V. Same-sex marriage, autoimmune thyroid gland dysfunction and other autoimmune diseases in Denmark 1989–2008. Eur J Epidemiol 29, 63–71 (2014). https://doi.org/10.1007/s10654-013-9869-9

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Keywords

  • Autoimmune diseases
  • Denmark
  • Epidemiology
  • Graves’ disease
  • Hashimoto’s thyroiditis
  • Homosexuality