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Social Disparities among Sudden Death victims with HIV

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Abstract

Although cardiovascular death is a growing source of mortality for people living with human immunodeficiency virus (HIV), the risk factors and circumstances surrounding sudden death in this population are poorly understood. We compared 399 adult sudden death victims reported by Emergency Medical Services in North Carolina to 1,114 controls. Sudden death was more common among HIV-positive than HIV-negative individuals (OR: 2.59, 95% CI: 1.15–5.83). In a multivariable model of sudden death victims including Black race, BMI, and history of divorce, incarceration, substance abuse, and respiratory disease, HIV-positive individuals were more likely to be Black (adjusted OR [aOR]: 6.04, 95% CI: 1.08–33.7) or divorced (aOR: 4.71, 95% CI: 1.04–21.3), adjusted for all other variables in the model. Compared to controls with HIV, sudden death victims with HIV were more likely to have a history of incarceration, divorce, respiratory disease, alcohol abuse, or dyslipidemia. A qualitative assessment of victims suggested that many died in isolation, suffering from past and current substance abuse and depression. HIV infection appears to be an important risk factor for sudden death, and incarceration history, social isolation, and medical comorbidities contribute to sudden death risk for HIV-positive individuals.

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Acknowledgements

The Wake County EMS Data System supports, maintains, and monitors EMS service delivery, patient care, and disaster preparedness for the Wake County, NC, community at large. This manuscript has been reviewed by Wake County EMS Data System investigators for scientific content and consistency of data interpretation with previous Wake County EMS Data System publications. We would like to thank the North Carolina Office of the Chief Medical Examiner, SUDDEN team of researchers, and the Carolina Data Warehouse/North Carolina Translational and Clinical Sciences Institute at University of North Carolina at Chapel Hill.

Funding

The SUDDEN project is funded by individual, private donations, The Heart and Vascular Division of the University of North Carolina at Chapel Hill, and the McAllister Heart Institute. The project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR002489. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Department of Medicine, Department of Medicine, Washington University in St. Louis School of Medicine, 63110, St. Louis, Missouri, United States of America

    Melissa D. Klein

  2. Preventive Medicine Residency, Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America

    Susan K. Keen

  3. Department of Medicine, Brown University, Providence, Rhode Island, United States of America

    Pranavi Sanka

  4. Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America

    Elizabeth Senter

  5. The North Carolina Translational & Clinical Sciences Institute, Chapel Hill, NC, United States of America

    Feng-Chang Lin

  6. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America

    Hannah Jones

  7. Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America

    Justin L. Vandermolen & Ross J. Simpson Jr.

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  1. Melissa D. Klein
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  2. Susan K. Keen
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  3. Pranavi Sanka
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  4. Elizabeth Senter
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  5. Feng-Chang Lin
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  6. Hannah Jones
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  7. Justin L. Vandermolen
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  8. Ross J. Simpson Jr.
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Contributions

MDK, SKK, JLV, and RJS contributed to study design. MDK, SKK, PS, ES, FCL, HJ, and JLV performed data extraction and analysis. MDK, SKK, ES, JLV, and RJS edited the manuscript. All authors critically reviewed the manuscript.

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Correspondence to Melissa D. Klein.

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This study was approved by the University of North Carolina at Chapel Hill (IRB 14-2036).

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Klein, M.D., Keen, S.K., Sanka, P. et al. Social Disparities among Sudden Death victims with HIV. AIDS Behav 26, 3974–3980 (2022). https://doi.org/10.1007/s10461-022-03723-4

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  • DOI: https://doi.org/10.1007/s10461-022-03723-4

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