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Canadian Journal of Public Health

, Volume 101, Issue 5, pp 415–419 | Cite as

Regional and Temporal Changes in HIV-related Mortality in British Columbia, 1987–2006

  • Viviane D. Lima
  • Katherine J. Lepik
  • Wendy Zhang
  • Katherine A. Muldoon
  • Robert S. Hogg
  • Julio S. G. Montaner
Quantitative Research
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Abstract

Background

HIV-related mortality has been declining in Canada; however, little is known about regional differences in HIV-related mortality. The objective of this study was to characterize regional changes in HIV-related mortality from 1987–2006 in British Columbia (BC).

Methods

BC Vital Statistics provided death certificate data for individuals ≥18 years who died of an HIV-related cause in BC between 1987 and 2006. Annual mortality rates were calculated for all BC, five regional health authorities, and two areas within Vancouver. Joinpoint regression analyses measured changes in mortality rates.

Results

There were 3,899 HIV-related deaths in BC from 1987–2006. Over time, HIV-related mortality rates were highest in the densely populated, southern regions, and lowest in the north. In BC, mortality significantly increased from 1987–1994 (annual percent change [APC] 16.3%). In 1994, the trend changed to a significant decrease in mortality from 1994–1998 (APC -20.0%), followed by a sustained reduction from 1998–2006. Four of the five health authorities showed mortality trends similar to the province; however, the north showed significantly increasing mortality from 1987–2006 (APC 6.7%). In Vancouver, the City Centre showed a mortality pattern similar to the province, but the Downtown Eastside had rising mortality rates until 1997, followed by a modest decline.

Conclusion

In most areas of BC, HIV-related mortality declined after the introduction of effective antiretroviral therapy; however, this decline was delayed or absent in some regions. These regional variations may reflect differential access to health care, even in a setting where antiretroviral therapy is provided at no cost to patients.

Key words

Mortality mortality decline death rate HIV Canada British Columbia 

Résumé

Contexte

La mortalité liée au VIH diminue au Canada, mais on en sait peu sur les écarts régionaux. Nous avons voulu caractériser les changements régionaux dans la mortalité liée au VIH de 1987 à 2006 en Colombie-Britannique (C.-B.).

Méthode

Dans les statistiques démographiques de la province, nous avons répertorié les personnes ≥18 ans décédées de causes liées au VIH entre 1987 et 2006. Les taux de mortalité annuels ont été calculés pour toute la C.-B., pour les cinq régies régionales de la santé et pour deux secteurs de Vancouver. Des analyses de régression aux points de jonction ont mesuré l’évolution des taux.

Résultats

Il y a eu 3899 décès liés au VIH en C.-B. de 1987 à 2006. Sur la période, les taux de mortalité les plus élevés se trouvaient dans les régions densément peuplées du Sud, et les plus faibles, dans le Nord. La mortalité en C.-B. a beaucoup augmenté de 1987 à 1994 (pourcentage de changement annuel [PCA] 16,3 %). Elle a accusé une baisse importante (PCA -20 %) de 1994 à 1998, puis une baisse soutenue de 1998 à 2006. Quatre des cinq régies régionales affichent des tendances semblables à celle de la province, mais dans le Nord, la mortalité s’est sensiblement accrue de 1987 à 2006 (PCA 6,7 %). Au centre-ville de Vancouver la structure de la mortalité était semblable à celle de la province, mais dans le quartier Downtown Eastside, les taux de mortalité ont grimpé jusqu’en 1997, puis diminué légèrement.

Conclusion

Presque partout en C.-B., la mortalité liée au VIH a baissé après l’introduction de traitements antirétroviraux efficaces, mais cette baisse a été retardée ou absente dans certaines régions. Les écarts régionaux pourraient s’expliquer par des inégalités d’accès aux soins de santé, même là où les traitements antirétroviraux sont fournis gratuitement.

Mots clés

mortalité baisse de la mortalité taux de mortalité VIH Canada Colombie-Britannique 

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Copyright information

© The Canadian Public Health Association 2010

Authors and Affiliations

  • Viviane D. Lima
    • 1
    • 2
  • Katherine J. Lepik
    • 1
    • 3
  • Wendy Zhang
    • 1
  • Katherine A. Muldoon
    • 1
  • Robert S. Hogg
    • 1
    • 4
  • Julio S. G. Montaner
    • 1
    • 2
  1. 1.British Columbia Centre for Excellence in HIV/AIDSSt. Paul’s HospitalVancouverCanada
  2. 2.Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  3. 3.Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverCanada
  4. 4.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada

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