Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 19;10(1):ofac678.
doi: 10.1093/ofid/ofac678. eCollection 2023 Jan.

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

Rachael A Pellegrino  1   2 , Peter F Rebeiro  2   3 , Megan Turner  2 , Amber Davidson  4 , Noelle Best  2 , Chandler Shaffernocker  2 , Asghar Kheshti  2 , Sean Kelly  2 , Stephen Raffanti  2 , Timothy R Sterling  2 , Jessica L Castilho  2   5
Affiliations

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

Rachael A Pellegrino et al. Open Forum Infect Dis. .

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 to December 2018. Mortality rates were compared by demographic and clinical factors, and adjusted incidence rate ratios (aIRRs) 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 6531 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 with 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 with men (aIRR, 1.31; 95% CI, 1.12-1.54). Of those who died, Black women had the highest aYPLL (aIRR, 592.5; 95% CI, 588.4-596.6), followed by Black men (aIRR, 470.7; 95% CI, 468.4-472.9), White women (aIRR, 411.5; 95% CI, 405.6-417.4), then White men (aIRR, 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.

Keywords: HIV; health care disparities; mortality; premature mortality; years of potential life lost.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. All authors: no reported conflicts of interest.

Figures

Figure 1.
Figure 1.
Unadjusted mortality rates by calendar era among individuals cared for at the VCCC, 1998–2018, by demographic and clinical characteristics, including (A) age during calendar era, (B) gender, (C) race/ethnicity, (D) history of injection drug use as HIV acquisition risk factor, (E) any history of hepatitis C virus infection, and (F) CD4 cell count at clinic entry. The 1998–2003 calendar era includes 1737 individuals, 4722.44 person-years, and 166 deaths. The 2004–2008 calendar era includes 3176 individuals, 11 044.57 person-years, and 313 deaths. The 2009–2013 calendar era includes 4285 individuals, 17 436.78 person-years, and 287 deaths. The 2014–2018 calendar era includes 5765 individuals, 24 313.98 person-years, and 190 deaths.
Figure 2.
Figure 2.
Age-adjusted years of potential life lost rates (95% CI) among individuals cared for at the VCCC who died during the study period (1998–2018), by (A) sex and race/ethnicity and (B) HIV acquisition risk factor. Abbreviations: aYPLL, age-adjusted years of potential life lost; MSM, men who have sex with men; VCCC, Vanderbilt Comprehensive Care Clinic.
See this image and copyright information in PMC

References

    1. Samji H, Cescon A, Hogg RS, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One 2013; 8:e81355. - PMC - PubMed
    1. Bosh KA, Johnson AS, Hernandez AL, et al. Vital signs: deaths among persons with diagnosed HIV infection, United States, 2010–2018. MMWR Morb Mortal Wkly Rep 2020; 69:1717–24. - PMC - PubMed
    1. Harrison KMD, Song R, Zhang X. Life expectancy after HIV diagnosis based on national hiv surveillance data from 25 states, United States. J Acquir Immune Defic Syndr 2010; 53:124–30. - PubMed
    1. Castilho JL, Melekhin V V, Sterling TR. Sex differences in HIV outcomes in the highly active antiretroviral therapy era: a systematic review. AIDS Res Hum Retroviruses 2014; 30:446–56. - PMC - PubMed
    1. Centers for Disease Control and Prevention . Estimated HIV incidence and prevalence in the United States, 2015–2019. HIV Surveill Suppl Rep 2021; 26:1–81.