IDWeek 2021: Despite declining mortality rates among patients with HIV in the past 2 decades, a new study finds significant disparities in gender and race.
Although mortality rates among people with HIV (PWH) have decreased since antiretroviral therapy became available, this trend may not quantify premature deaths among PWH, noted researchers led by Rachael Pellegrino, MD, MPH, resident physician, Vanderbilt University Medical Center in Nashville, Tennessee.
Researchers examined all-cause and premature mortality trends and disparities by race, sex, and HIV risk factor among PWH who received care at the Vanderbilt Comprehensive Care Clinic from January 1998 to December 2018.
A total of 6531 PWH (51% non-Hispanic White, 40% non-Hispanic [NH] Black, 21% women) were included in the study, of whom 956 (14.6%) died. Mortality rates significantly decreased among all participants during the study period.
After adjusting for factors including age, CD4 cell counts, injection drug use, hepatitis C virus (HCV), and HIV RNA at clinic entry, the data showed that only female sex (aIRR=1.32, 95% CI: 1.13–1.55 vs males) but not NH Black race (aIRR=1.02, 95% CI: 0.88–1.17 vs. NH White race) was associated with increased mortality.
Researchers also calculated premature mortality, or years of potential life lost (YPLL), by comparing age at death among participants who died to age- and sex-specific life expectancy from US general-population life tables.
In contrast to mortality rate findings, researchers found that age-adjusted YPLL (aYPLL) per 1000-person years was significantly higher for both women and NH Black PWH. Specifically, aYPLL per 1000 person-years was highest for Black women (592.5; 95% CI, 588.4-596.6), followed by Black men (470.7; 95% CI, 468.5-472.9), White women (411.5; 95% CI, 405.6-417.4), and White men (308.6; 95% CI, 308-309.2).
Using models adjusted for CD4 cell count, HIV RNA, HCV, and year of clinic entry, Pellegrino et al found that higher YPLL remained associated with NH Black race, female sex regardless of HIV risk factor, and younger age at HIV diagnosis.
“Despite marked improvement over time, sex disparities in mortality as well as sex and race disparities in YPLL remained among PWH in care in this cohort. YPLL is a useful measure for examining persistent gaps in longevity and premature mortality among PWH,” concluded researchers.
Reference: Pellegrino R, Rebeiro PF, Turner M, et al. Sex and race disparities in premature mortality among people with HIV: A 21-year observational cohort study. Abstract (53) presented at: IDWeek 2021; held online September 29-October 3, 2021.