Nash Denis, Katyal Monica, Shah Sarita
Mailman School of Public Health, Columbia University, 722 W, 168th Street, 7th Floor, New York, NY 10032, USA.
J Urban Health. 2005 Dec;82(4):584-600. doi: 10.1093/jurban/jti123. Epub 2005 Oct 19.
To examine trends in predictors of HIV-related mortality among cohorts of persons living with AIDS (PLWA) in New York City (NYC), nine calendar year-specific cohorts of PLWA were created from 1993 to 2001. Cohorts were defined as persons who had been alive at any time during that year and had been diagnosed with AIDS before the end of that year. Predictors of death because of HIV-related causes of death were assessed by examining year-specific, stratified death rates per 1,000 PLWA and adjusted relative risks (RRs) from proportional hazards models. We conducted an analysis of AIDS surveillance data PLWA in NYC between 1993 and 2001. Univariate and multivariate Cox proportional hazards models were constructed for each calendar year cohort to evaluate trends in the RR of HIV-related death over the subsequent 5 years, adjusting for sex, race/ethnicity, age, transmission risk, borough of residence, category of AIDS diagnosis [opportunistic illness (OI) or CD4 count <200 cells/microL], time since AIDS diagnosis, and CD4 count at time of AIDS diagnosis. Death rates due to all causes and HIV-related causes declined substantially during 1993-1997 and then stabilized in all subgroups of PLWA between 1998 and 2001. Beginning in 1995, differences in survival emerged in some subgroups, such that by 2001 (1) injecting drug users (IDUs) had poorer survival compared with men who have sex with men (MSM) [RR(2001) = 2.1, 95% confidence intervals (95% CI) = 1.8-2.4]; (2) black and Hispanic PLWA had a significantly higher risk of death than white PLWA (RR(2001) = 1.4, 95% CI = 1.2-1.6, RR(2001) = 1.2, 95% CI = 1.1-1.4, respectively, and (3) PLWA aged 60 and above had poorer survival compared with younger persons (RR(2001) = 2.4, 95% CI = 1.9-3.0), after adjustment for other factors. The observed disparities that began to emerge in 1995 may be attributable to differential effects of, access to, or usage of highly active antiretroviral therapy (HAART). More targeted studies are needed to determine why such disparities have emerged.
为研究纽约市艾滋病患者（PLWA）队列中与HIV相关死亡率的预测因素趋势，我们从1993年至2001年创建了9个按日历年划分的PLWA队列。队列定义为在该年任何时间存活且在该年年末前被诊断出患有艾滋病的人。通过检查每1000名PLWA的年度分层死亡率以及比例风险模型得出的调整后相对风险（RR），评估因HIV相关死因导致的死亡预测因素。我们对1993年至2001年纽约市PLWA的艾滋病监测数据进行了分析。为评估随后5年中HIV相关死亡RR的趋势，针对每个日历年队列构建了单变量和多变量Cox比例风险模型，并对性别、种族/族裔、年龄、传播风险、居住行政区、艾滋病诊断类别[机会性感染（OI）或CD4细胞计数<200个/微升]、自艾滋病诊断后的时间以及艾滋病诊断时的CD4细胞计数进行了调整。在1993 - 1997年期间，所有原因和HIV相关原因导致的死亡率大幅下降，然后在1998年至2001年期间在PLWA的所有亚组中趋于稳定。从1995年开始，一些亚组中出现了生存差异，到2001年时：（1）注射吸毒者（IDU）的生存率低于男男性行为者（MSM）[RR（2001）= 2.1，95%置信区间（95%CI）= 1.8 - 2.4]；（2）黑人和西班牙裔PLWA的死亡风险显著高于白人PLWA（RR（2001）分别为1.4，95%CI = 1.2 - 1.6；RR（2001）= 1.2，95%CI = 1.1 - 1.4）；（3）在对其他因素进行调整后，60岁及以上的PLWA与较年轻者相比生存率较低（RR（2001）= 2.4，95%CI = 1.9 - 3.0）。1995年开始出现的这些观察到的差异可能归因于高效抗逆转录病毒治疗（HAART）的不同效果、可及性或使用情况。需要进行更具针对性的研究来确定为何会出现这种差异。
