Article

Disparities among US states in HIV-related mortality in persons with HIV infection, 2001–2007

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
AIDS (London, England) (Impact Factor: 6.56). 01/2012; 26(1):95-103. DOI: 10.1097/QAD.0b013e32834dcf87
Source: PubMed

ABSTRACT To examine interstate variation in US HIV case-fatality rates, and compare them with corresponding conventional HIV death rates.
Cross-sectional analysis using data on deaths due to HIV infection from the National Vital Statistics System and data on persons 15 years or older living with HIV infection in 2001-2007 in 37 US states from the national HIV/AIDS Reporting System.
State rankings by age-adjusted HIV case-fatality rates (with HIV-infected population denominators) were compared with rankings by conventional death rates (with general population denominators). Negative binomial regression determined case-fatality rate ratios among states, adjusted for age, sex, race/ethnicity, year, and state-level markers of late HIV diagnosis.
On the basis of 3,096,729 HIV-infected person-years, the overall HIV case-fatality rate was 20.6 per 1000 person-years [95% confidence interval (CI) 20.3-20.9]. Age-adjusted rates by state ranged from 9.6 (95% CI 6.8-12.4) in Idaho to 32.9 (95% CI 29.8-36.0) in Mississippi, demonstrating significant differences across states, even after adjusting for race/ethnicity (P < 0.0001). Many states with low conventional death rates had high case-fatality rates. Nine of the 10 states with the highest case-fatality rates were located in the southern United States.
Case-fatality rates complement and are not entirely concordant with conventional death rates. Interstate differences in these rates may reflect differences in secondary and tertiary prevention of HIV-related mortality among infected persons. These data suggest that state-specific contextual barriers to care may impede improvements in quality and disparities of healthcare without targeted interventions.

Full-text

Available from: Stephen Gange, Sep 19, 2014
2 Followers
 · 
151 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study is the first published multi-app study, of which we are aware, to evaluate both the acceptability and feasibility of providing sexual health information and HIV/STD testing referrals via established geosocial and sexual networking apps for MSM. Data were collected using an online survey and through four apps (A4A Radar, Grindr, Jack'd, and Scruff). Two-thirds (64 %) found apps to be an acceptable source for sexual health information. MSM who found apps as acceptable were more likely non-white, not sure of their current HIV status, and have low HIV testing self-efficacy. One-quarter (26 %) of informational chats with the health educator resulted in users requesting and being referred to local HIV/STD testing sites. There were significant differences in the number and types of interactions across apps. Established apps designed for MSM may be both an acceptable and feasible platform to promote HIV/STD testing. Future research should evaluate interventions that leverage this technology.
    AIDS and Behavior 11/2014; 19(3). DOI:10.1007/s10461-014-0942-5 · 3.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A group of nine states in the Southern United States, hereafter referred to as the targeted states, has experienced particularly high HIV diagnosis and case fatality rates. To provide additional information about the HIV burden in this region, we used CDC HIV surveillance data to examine characteristics of individuals diagnosed with HIV in the targeted states (2011), 5-year HIV and AIDS survival, and deaths among persons living with HIV (2010). We used multivariable analyses to explore the influence of residing in the targeted states at diagnosis on deaths among persons living with HIV after adjustment for demographics and transmission risk. In 2011, the targeted states had a higher HIV diagnosis rate (24.5/100,000 population) than the US overall (18.0/100,000) and higher proportions than other regions of individuals diagnosed with HIV who were black, female, younger, and living in suburban and rural areas. Furthermore, the targeted states had lower HIV and AIDS survival proportions (0.85, 0.73, respectively) than the US overall (0.86, 0.77, respectively) and the highest death rate among persons living with HIV of any US region. Regional differences in demographics and transmission risk did not explain the higher death rate among persons living with HIV in the targeted states indicating that other factors contribute to this disparity. Differences in characteristics and outcomes of individuals with HIV in the targeted states are critical to consider when creating strategies to address HIV in the region, as are other factors identified in previous research to be prominent in the region including poverty and stigma.
    Journal of Community Health 12/2014; DOI:10.1007/s10900-014-9979-7 · 1.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The comparative mortality figure (CMF) is the expected number of deaths in the standard population compared with those observed. We assessed state-based CMFs for people with HIV infection to allow standardized assessment of mortality in all states. We used National HIV Surveillance System data to compute CMFs for people diagnosed with HIV and AIDS from 2001 to 2010 who met the CDC HIV case definition; were alive on December 31, 2009; and died during 2010. In 33 U.S. states with name-based HIV reporting since 2001, the 2010 CMF for people with an HIV diagnosis was 2.8 compared with 4.5 for those with an AIDS diagnosis. CMFs for males were higher than for females (3.4 vs. 3.1) and black people had higher CMFs than white people for HIV (3.2 vs. 2.2) and AIDS (4.7 vs. 4.3). CMFs by state ranged from 0.9 to 4.2 for HIV and 1.9 to 9.7 for AIDS. In 50 states and the District of Columbia with AIDS reporting, CMFs for males and females were similar (4.5 and 4.6, respectively), CMFs for black people remained higher than for white people (5.0 and 3.9, respectively), and the range for states remained broad (1.2-9.4). State mortality figures varied based on population composition and disease stage at diagnosis, possibly indicating a need for state-specific testing, linkage to care, and viral suppression strategies to reduce mortality.
    Public Health Reports 05/2015; 130(3):253-60. · 1.64 Impact Factor