Antiretroviral Therapy and Declining AIDS Mortality in New York City

Messeri, Peter; Lee, Gunjeong; Abramson, David M.; Aidala, Angela A.; Chiasson, Mary Ann; Jessop, Dorothy Jones

doi:10.1097/01.mlr.0000053230.81725.ef

Cited by 33 publications

(23 citation statements)

References 12 publications

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“…26 Few prior studies in HIV patients have considered differences in clinical outcomes among Hispanic patients compared with other racial/ethnic groups. 4,10,11,13 Of these, 3 reported similar 4,10,13 and 1 reported worse 11 clinical outcomes for Hispanic compared with White patients. Our study is the first to report significantly reduced mortality for HIVinfected Hispanic patients.…”

Section: Discussionmentioning

confidence: 93%

“…Others have investigated differences in the risk of AIDS or death by race/ethnicity, [4][5][6][7][8][9][10][11][12] but few have included Hispanic patients. 4,10,11,13 Most studies have reported no racial/ethnic differences in clinical progression of HIV, [4][5][6][7][8][9][10]13 although 1 large study indicated that Black and Hispanic patients had higher mortality rates compared with White patients, 11 and another indicated higher mortality rates for Hepatitis C co-infected White compared with Black patients. 12 However, studies were limited by small sample sizes for certain racial/ethnic subgroups, 4,6,9,10,12,13 and limited 7,8,11 or no adjustment 9,12 for potential confounders.…”

Section: Introductionmentioning

confidence: 99%

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Race/Ethnicity and Risk of AIDS and Death Among HIV-infected Patients with Access to Care

et al. 2009

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BACKGROUND: Prior studies evaluating racial/ethnic differences in responses to antiretroviral therapy (ART) among HIV-infected patients have not adequately accounted for many potential confounders, and few have included Hispanic patients. OBJECTIVE:To identify racial/ethnic differences in ART adherence, and risk of AIDS and death after ART initiation for HIV patients with similar access to care. DESIGN:Retrospective cohort study.PARTICIPANTS: 4,686 HIV-infected patients (66% White, 20% Black, and 14% Hispanic) initiating ART and who were enrolled in an integrated healthcare system. MEASUREMENTS:Main outcomes evaluated were ART adherence, new AIDS clinical events, and all-cause mortality. The potential confounding effects of demographics, socioeconomic status, ART parameters, HIV disease stage, and other clinical parameters were considered in multivariable models. RESULTS:Adjusted mean adherence levels were higher among White (70.1%; ref) compared with Black (64.2%; P<0.001) and Hispanic patients (65.2%; P< 0.001). Adjusted hazard ratios (HR) for the risk of new AIDS events (White patients as reference) were 1.3 (P=0.09) for Black and 0.9 (P=0.64) for Hispanic patients. The adjusted HR for AIDS comparing Hispanic to Black patients was 0.7 (P=0.11). Hispanic patients had fewer deaths compared with other racial/ethnic groups, particularly cancer and cardiovascular-related. However, adjusted HRs for death were 1.2 (P=0.37) and 0.9 (P=0.62) for Black and Hispanic patients, respectively, compared with White patients and 0.9 (P= 0.63) for Hispanic compared with Black patients. Adjustment for adherence did not change inferences for AIDS or death. CONCLUSIONS:In the setting of similar access to care, we did not observe a disparity for the risk of clinical events for racial/ethnic minorities, despite lower ART adherence.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Race/Ethnicity and Risk of AIDS and Death Among HIV-infected Patients with Access to Care

et al. 2009

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“…Finally, NYC has long had aggressive public health initiatives to combat major contributors to mortality, with a focus on public policy and prevention efforts among low SES areas of the city. These include intensive tobacco control measures, 16 ongoing aggressive identification and treatment of persons infected with HIV, 17 monitoring and initiating efforts to reduce obesity and diabetes, 18 increased colorectal cancer screening, and outreach to neighborhoods with poor population health indicators through three district public health offices, which conduct activities including delivery of preventive services for hypertension and outreach to limit consumption of sugary drinks. 18 These efforts might have contributed to the continued mortality disparity reductions during 2000-2010.…”

Section: Discussionmentioning

confidence: 99%

Trends in Mortality Disparities by Area-Based Poverty in New York City, 1990–2010

Toprani

Hadler

2016

J Urban Health

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Residing in a high-poverty area has consistently been associated with higher mortality rates, but the association between poverty and mortality can change over time. We examine the association between neighborhood poverty and mortality in New York City (NYC) during 1990-2010 to document mortality disparity changes over time and determine causes of death for which disparities are greatest. We used NYC and New York state mortality data for years 1990, 2000, and 2010 to calculate all-cause and cause-specific age-adjusted death rates (AADRs) by census tract poverty (CTP), which is the proportion of persons in a census tract living below the federal poverty threshold. We calculated mortality disparities, measured as the difference in AADR between the lowest and highest CTP groups, within and across race/ethnicity, nativity, and sex categories by year. We observed higher all-cause AADRs with higher CTP for each year for all race/ethnicities, both sexes, and US-born persons. Mortality disparities decreased progressively during 1990-2010 for the NYC population overall, for each race/ethnic group, and for the majority of causes of death. The overall mortality disparity between the highest and lowest CTP groups during 2010 was 2.55 deaths/ 1000 population. The largest contributors to mortality disparities were heart disease (51.52 deaths/100,000 population), human immunodeficiency virus (19.96/100,000 population), and diabetes (19.59/100,000 population). We show that progress was made in narrowing socioeconomic disparities in mortality during 1990-2010, but substantial disparities remain. Future efforts toward achieving health equity in NYC mortality should focus on areas contributing most to disparities.

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“…This study is a longitudinal cohort study of people living with HIV in New York City and is conducted by Columbia University School of Public Health (Messeri, Lee, Abramson, Aidala, Chiasson, and Jessop 2003). The CHAIN cohort was recruited in 1994 from a large number of medical care and social service agencies serving HIV in New York City.…”

Section: A Study Of Hiv-positive People In New York Citymentioning

confidence: 99%

“…These features include: (1) Bayesian regression models to address problems with separation; (2) imputation steps that deal with semi-continuous data; (3) modeling strategies that handle issues of perfect correlation and structural correlation; (4) functions that check the convergence of the imputations; and (5) plotting functions that visually check the imputation models. In Section 4, we demonstrate how to apply these functions using an example of a study of people living with HIV in New York City (Messeri, Lee, Abramson, Aidala, Chiasson, and Jessop 2003). In Section 5, we discuss future plans for our mi package.…”

Section: Introductionmentioning

confidence: 99%

Multiple Imputation with Diagnostics (mi) inR: Opening Windows into the Black Box

Su¹,

Gelman²,

Hill³

et al. 2011

J. Stat. Soft.

429

343

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Our mi package in R has several features that allow the user to get inside the imputation process and evaluate the reasonableness of the resulting models and imputations. These features include: choice of predictors, models, and transformations for chained imputation models; standard and binned residual plots for checking the fit of the conditional distributions used for imputation; and plots for comparing the distributions of observed and imputed data. In addition, we use Bayesian models and weakly informative prior distributions to construct more stable estimates of imputation models. Our goal is to have a demonstration package that (a) avoids many of the practical problems that arise with existing multivariate imputation programs, and (b) demonstrates state-of-the-art diagnostics that can be applied more generally and can be incorporated into the software of others.

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Antiretroviral Therapy and Declining AIDS Mortality in New York City

Abstract: These results demonstrate that in the case of HAART, the therapeutic benefits of an innovative but costly medical treatment are reaching populations that traditionally have poor access to quality health care.

Cited by 33 publications

References 12 publications

Race/Ethnicity and Risk of AIDS and Death Among HIV-infected Patients with Access to Care

Race/Ethnicity and Risk of AIDS and Death Among HIV-infected Patients with Access to Care

Trends in Mortality Disparities by Area-Based Poverty in New York City, 1990–2010

Multiple Imputation with Diagnostics (mi) inR: Opening Windows into the Black Box

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