HIV / STI
Patterns of Mortality by Cause among People with HIV in the United States from 2009-2016 Onumaraekwu Opara* Onumaraekwu Opara Opara Opara Opara Opara Opara Opara Opara Opara Opara Opara Opara Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
As mortality patterns among people with HIV (PWH) evolve, analysis of these trends is needed to develop focused prevention measures. We characterized patterns of mortality by cause and differences by age, sex, and race/ethnicity among PWH decedents.
We constructed annual cross-sectional cohorts of Medicare beneficiaries with HIV who died between 2009-2016 and were linked to the National Death Index to determine cause of death. Descriptive statistics summarized trends of proportionate mortality by cause over time, stratified by age group (<50, 50-64, and 65+ years). Logistic regression models were fit to assess associations between sex and race/ethnicity and cause of death across all years, adjusted for age, Rural-Urban Commuting Area, dual eligibility with Medicaid, and Medicare enrollment reason.
The final sample included 20,290 PWH that died between 2009-2016. The number of deaths remained stable from 2009 (2586 deaths) to 2016 (2595 deaths). HIV/AIDS was the leading cause of death across all years and age groups (Figure 1), though its contribution declined by one-third from 45.6% in 2009 to 29.9% in 2016 (p<0.0001). Among those <50 years, HIV/AIDS, substance use/violent death, and cardiovascular causes were the top causes of death. For those 50-64 and 65+ years, HIV/AIDS, cardiovascular causes, and malignancy were the top causes of death. Female PWH were less likely to die from HIV/AIDS (aOR 0.84, CI:0.76-0.93) and substance use/violent deaths (aOR 0.65, CI:0.54-0.80) than males. Racial and ethnic minorities were more likely to die from cardiovascular causes (Black aOR 1.22, CI:1.09-1.37) and HIV/AIDS (Black aOR 1.24, CI:1.13-1.36), but less likely to die from malignancy (Hispanic aOR 0.67, CI:0.48-0.95) and substance use/violent deaths (Black aOR 0.53, CI:0.45-0.63; Hispanic aOR 0.60, CI:0.41-0.89) than Whites.
Among PWH, disparities in mortality by cause persist along sociodemographic lines, underscoring the need for targeted prevention and treatment efforts.
