Among people with HIV, Black women have highest rate of premature death
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A 21-year study showed that, among people with HIV, Black women had the highest rate of premature death, researchers reported during IDWeek.
Rachael Pellegrino, MD, MPH, a resident physician at Vanderbilt University Medical Center (VUMC), and colleagues assessed mortality trends from 1998 to 2018 for people with HIV using person-time from clinic entry to date of death.
Among 6,531 people included in the study, 51% were non-Hispanic white, 40% were non-Hispanic Black, 21% were female, and 14.6% died.
After adjusting for calendar era, age, injection drug use, hepatitis C, year of HIV diagnosis, history of AIDS-defining illness, CD4 cell count and HIV RNA at clinic entry, the researchers found that being female (adjusted incidence rate ratio [aIRR] = 1.32; 95% CI, 1.13-1.55 vs. males) — but not of non-Hispanic Black race (aIRR = 1.02; 95% CI, 0.88-1.17 vs. non-Hispanic white) — was associated with increased mortality.
However, higher years of potential life lost remained associated with being Black and female, regardless of HIV risk factor or a younger age at HIV diagnosis.
“HIV is no longer a death sentence for millions living with the disease. While this progress is cause for celebration, we cannot ignore persistent disparities in outcomes that make women with HIV and Black women, in particular, more likely to die or die prematurely,” Pellegrino said in a press release.
Compared with white men with HIV, whose age-adjusted years of potential life lost was 308.6 per 1,000 person-years (95% CI, 308-309.2), the calculation was almost double among black women with HIV at 592.5 per 1,000 person-years (95% CI, 588.4-596.6).
“Years of potential life lost, or premature mortality, is a measure that hasn’t been widely used in HIV research,” Jessica L. Castilho, MD, MPH, coauthor of the study, and assistant professor of medicine at VUMC, said in the release. “We tend to focus on death as the outcome but looking at years of potential life lost gives us a different perspective on the impact of health disparities.”
According to Castilho, the assessment of premature mortality allows researchers to look at the distribution of early deaths in certain communities.
“Identification of ways to improve outcomes particularly for women and persons of color living with HIV are needed,” Castilho told Healio. “Improving these disparities will be tied closely with addressing the social determinants of health that create and reinforce these inequities.”
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Pellegrino R, et al. Abstract 53. Presented at: IDWeek; Sept. 29-Oct. 3, 2021 (virtual meeting).
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