Sex and Race Disparities in Mortality and Years of Potential Life Lost Among People With HIV: A 21-Year Observational Cohort Study

Abstract

Background Since the availability of antiretroviral therapy, mortality rates among people with HIV (PWH) have decreased; however, this does not quantify premature deaths among PWH, and disparities persist. Methods We examined all-cause and premature mortality among PWH receiving care at the Vanderbilt Comprehensive Care Clinic from January 1998 – December 2018. Mortality rates were compared by demographic and clinical factors and adjusted incidence rate ratios (aIRR) were calculated using multivariable Poisson regression. For individuals who died, age-adjusted years of potential life lost (aYPLL) per total person-years living with HIV were calculated from US sex-specific life tables, and sex and race differences were examined using multivariable linear regression. Results Among 6,531 individuals (51% non-Hispanic [NH] White race, 40% NH Black race, 21% cis-gender women, 78% cis-gender men) included, 956 (14.6%) died. In adjusted analysis, PWH alive in the most recent calendar era (2014-2018) had decreased risk of mortality compared to those in the earliest calendar era (1998-2003) (aIRR = 0.22 [95% CI: 0.17-0.29]), and women had increased risk of death compared to men (aIRR = 1.31 [95% CI: 1.12-1.54]). Of those who died, Black women had the highest aYPLL (592.5 [95% CI 588.4-596.6]), followed by Black men (470.7 [95% CI 468.4-472.9]), White women (411.5 [95% CI 405.6-417.4]), then White men (308.6 [95% CI 308.0-309.2]). In adjusted models, higher YPLL remained associated with NH Black race and cis-gender women, regardless of HIV risk factor. Conclusions Despite marked improvement over time, sex disparities in mortality as well as sex and race disparities in YPLL remained among PWH in this cohort.

Age-associated dementia among older people aging with HIV in the United States: a modeling study

“…estimates of non-HIV-related mortality among PWH. We found that this effect was more substantial among female individuals than male individuals with HIV, given the demographics of female individuals at highest risk for HIV acquisition [55][56][57], resulting in a lower modelprojected lifetime AAD cumulative incidence among female individuals with diagnosed HIV compared with female individuals in the general population.…”

Progress towards achieving national goals for improved quality of life among cis-gender Black women with HIV

“…People with long-standing exposure to both HIV and antiretroviral therapy (ART) are at a significantly increased risk of developing cardiovascular disease and cardiac dysfunction [1,2]. However, no robust options are currently available for identifying which persons with HIV (PWH) are at the highest risk of future cardiovascular disease [3,4]. We, therefore, performed proteomic profiling in biospecimens from children and young adults with HIV without clinical cardiac disease, comparing those with and without evidence of subclinical cardiac dysfunction, as evidenced by an abnormal myocardial performance index (MPI).…”

“…Social and structural determinants of health place Black women at higher risk for adverse HIV treatment outcomes. For example, only 62% of Black women are estimated to have achieved sustained viral suppression (compared with 70% of white women) [2] and Black women are more likely to die prematurely because of HIV compared with both men and women of any race or ethnicity [3]. Recognizing this inequity, the National HIV/ AIDS Strategy (NHAS) 2022-2025 identified cis-gender Black women as a priority population for HIV prevention and treatment efforts.…”