Sex and Race Disparities in Premature Mortality Among People Living with HIV
Presenter: Rachael Pellegrino, MD, MPH, Resident, Vanderbilt University Medical Center, Nashville, Tennessee
A summary of Sex and Race Disparities in Premature Mortality among People with HIV: A 21-Year Observational Cohort Study, September 29, 2021
“Since the availability of antiretroviral therapy, mortality rates among people living with HIV (PLWH) have decreased. However, this trend may fail to quantify premature deaths among PLWH,” said Rachael Pellegrino, MD, MPH, Resident, Vanderbilt University Medical Center, Nashville, Tennessee.
Pellegrino continued, “A 21-year observational cohort study assessed trends and disparities in all-cause and premature mortality by sex, HIV risk factor, and race, among PLWH receiving care at the Vanderbilt Comprehensive Care Clinic in Nashville, Tennessee from January 1998 to December 2018. Mortality trends were examined using person-time from clinic entry to date of death or December 31, 2018. Mortality rates were compared according to demographic and clinical factors and calculated according to adjusted incidence rate ratios (IRR) and 95% confidence intervals (CI) using multivariable Poisson regression.”
“For individuals who died, years of potential life lost (YPLL) were obtained from the expected years of life remaining by referencing US sex-specific period life tables at age and year of death, and age-adjusted YPLL rates were also calculated,” continued Pellegrino. Patient factors associated with YPLL were examined using multivariable linear regression.
The study included 6,531 individuals: 51% were non-Hispanic White, 40% were non-Hispanic Black, and 21% were female. A total of 956 (14.6%) individuals died during the study time frame, and mortality rates dramatically decreased.
“After adjusting for calendar era, age, injection drug use, hepatitis C virus (HCV), year of HIV diagnosis, history of AIDS-defining illness, CD4 cell count, and HIV RNA at clinic entry, only female sex (adjusted IRR=1.32, 95% CI: 1.13–1.55 vs. males) but not non-Hispanic Black race (adjusted IRR=1.02, 95% CI: 0.88–1.17 vs. non-Hispanic White race) was associated with increased mortality,” said Pellegrino.
Pellegrino continued, “In contrast, adjusted YPLL per 1,000-person years was significantly higher for both female and non-Hispanic Black PLWH: non-Hispanic White male (308.6), non-Hispanic White female (411.5), non-Hispanic Black male (470.7), and non-Hispanic Black female (592.5).”
“In adjusted models including CD4 cell count, HIV RNA, HCV, and year of clinic entry, higher YPLL remained associated with non-Hispanic Black race, female sex regardless of HIV risk factor, and younger age at HIV diagnosis,” stated Pellegrino.
Pellegrino concluded, “Despite marked improvement over time, sex disparities in mortality as well as sex and race disparities in YPLL remained among PLWH in this cohort. YPLL is a useful measure for examining persistent gaps in longevity and premature mortality among PLWH.”
Disclosures
Rachael Pellegrino, MD, MPH: Nothing to disclose.
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. Presented virtually at: 10th Annual IDWeek 2021; September 29, 2021. Abstract 53.