Factors Associated with State Variation in Mortality Among Persons Living with Diagnosed HIV Infection
- 69 Downloads
In the United States, the all-cause mortality rate among persons living with diagnosed HIV infection (PLWH) is almost twice as high as among the general population. We aimed to identify amendable factors that state public health programs can influence to reduce mortality among PLWH. Using generalized estimating equations (GEE), we estimated age–group-specific models (24–34, 35–54, ≥ 55 years) to assess the association between state-level mortality rates among PLWH during 2010–2014 (National HIV Surveillance System) and amendable factors (percentage of Ryan White HIV/AIDS Program (RWHAP) clients with viral suppression, percentage of residents with healthcare coverage, state-enacted anti-discrimination laws index) while controlling for sociodemographic nonamendable factors. Controlling for nonamendable factors, states with 5% higher viral suppression among RWHAP clients had a 3–5% lower mortality rates across all age groups [adjusted Risk Ratio (aRR): 0.95, 95% Confidence Interval (CI): 0.92–0.99 for 24–34 years, aRR: 0.97, 95%CI: 0.94–0.99 for 35–54 years, aRR: 0.96, 95%CI: 0.94–0.99 for ≥ 55 years]; states with 5% higher health care coverage had 4–11% lower mortality rate among older age groups (aRR: 0.96, 95%CI: 0.93–0.99 for 34–54 years; aRR: 0.89, 95%CI: 0.81–0.97 for ≥ 55 years); and having laws that address one additional area of anti-discrimination was associated with a 2–3% lower mortality rate among older age groups (aRR: 0.98, 95%CI: 0.95–1.00 for 34–54 years; aRR: 0.97, 95%CI: 0.94–0.99 for ≥ 55 years). The mortality rate among PLWH was lower in states with higher levels of residents with healthcare coverage, anti-discrimination laws, and viral suppression among RWHAP clients. States can influence these factors through programs and policies.
KeywordsHIV/AIDS HIV testing Viral suppression Healthcare coverage Stigma
Publication of this manuscript was made possible by the contributions of the state and territorial health departments and the HIV surveillance programs that provided surveillance data to CDC and the Ryan White HIV/AIDS Program grant recipients and subrecipients that provided data to HRSA.
The authors received no financial support for the research, authorship, and/or publication of this article.
Compliance with Ethical Standards
Conflicts of interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- 2.Underlying Cause of Death 1999-2015 on CDC WONDER Online Database, released 2015. Data are from the multiple cause of death files, 1999-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program [database on the Internet]. CDC WONDER Online database. [cited July 5, 2017]. Available from: http://wonder.cdc.gov/ucd-icd10.html.
- 3.Underlying Cause of Death 1979-1998 on CDC WONDER online database. Data are from the underlying cause of death files, 1979-1998, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program [database on the internet]. CDC WONDER Online database. [cited July 5, 2017]. Retrieved from: https://wonder.cdc.gov/cmf-icd9.html.
- 5.Centers for Disease Control and Prevention. Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data—United States and 6 Dependent Areas—2015. July 2017; 22(2).Google Scholar
- 6.Centers for Disease Control and Prevention. Division of HIV/AIDS Prevention Strategic Plan, 2016–2020. July 2015.Google Scholar
- 7.Centers for Disease Control and Prevention. Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data—United States and 6 Dependent Areas—2014. July 2016; 21(4).Google Scholar
- 12.U.S. Department of Commerce. Economics and Statistics Administration U.S. Census Bureau. Census regions and divisions of the United States. U.S. Census Bureau. https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf. Accessed July 1, 2014.
- 13.U.S. Census Bureau: State and County QuickFacts. QuickFacts. U.S. Census Bureau. 2016. https://www.census.gov/quickfacts/fact/map/US/IPE120215#viewtop. Accessed August 29, 2017.
- 15.NCHHSTP AtlasPlus. [database on the Internet] [cited April 17, 2017]. Retrived from: https://www.cdc.gov/nchhstp/atlas/.
- 16.Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2016. http://hab.hrsa.gov/data/data-reports.November.
- 17.U. S. Census Bureau. American Community Survey. Accessed December 16, 2015, http://factfinder.census.gov/faces/nav/jsf/pages/programs.xhtml?program=acs.
- 18.Human Rights Campaign. State equality index. 2015. Accessed Septebmer 23, 2015, http://www.hrc.org/campaigns/state-equality-index.
- 19.National Center for Health Statistics. (2017). National vital statistics reports deaths: Leading causes for 2015. Hyattsville: National Center for Health Statistics.Google Scholar
- 21.Gates GJ. Sexual Minorities in the 2008 General Social Survey: Coming out and demographic characteristics. Los Angeles, CA: The Williams Institute, UCLA2010.Google Scholar
- 23.Health Resources and Services Administration. About the Ryan White HIV/AIDS Program. 2016. https://hab.hrsa.gov/about-ryan-white-hivaids-program/about-ryan-white-hivaids-program.
- 26.Whitehorn L, Domestic violence doubles risk of death for HIV-positive women. AIDS 2012; 2012; Washington DC. https://www.poz.com/article/hiv-women-violence-22757-8706.
- 27.Centers for Disease Control and Prevention. 10 Leading causes of death by age group, United States—2016. 2018. https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2016-508.pdf.