Legarth Rebecca, Omland Lars H, Kronborg Gitte, Larsen Carsten S, Pedersen Court, Gerstoft Jan, Obel Niels
aDepartment of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet bDepartment of Infectious Diseases, Copenhagen University Hospital, Hvidovre cDepartment of Infectious Diseases, Aarhus University Hospital, Aarhus dDepartment of Infectious Diseases, Odense University Hospital, Odense, Denmark.
AIDS. 2014 Jan 28;28(3):387-96. doi: 10.1097/QAD.0000000000000032.
To estimate association between educational attainment and risk of HIV diagnosis, response to HAART, all-cause, and cause-specific mortality in Denmark in 1998-2009.
Prospective, population-based cohort study including 1277 incident HIV-infected patients without hepatitis C virus or intravenous drug abuse identified in the Danish HIV Cohort Study and 5108 individually matched population controls.
Data on educational attainment, categorized as low, medium, or high, were identified in The Danish Attainment Register. Logistic and Poisson regression were used to estimate odds ratios (ORs) and mortality rate ratios (MRRs).
OR of HIV diagnosis was 1.7 (95% confidence interval, CI 1.3-2.3) among heterosexual individuals with low educational attainments, but no associations between educational attainment and time to HAART initiation, CD4 cell count, or viral suppression were identified. All-cause MRRs were 1.8 (95% CI 1.0-3.2) and 1.8 (1.1-2.8) for HIV-infected patients and population controls with low educational attainment compared with medium and high educational attainment. MRRs for smoking and alcohol-related deaths were 3.6 (95% CI 1.5-8.9) for HIV-infected patients and 2.0 (95% CI 1.2-3.4) for population controls with low educational attainment compared with medium and high educational attainment.
With free and equal access to healthcare, low educational attainment might increase risk of HIV infection among heterosexual individuals, but was not associated with late/very late presentation of HIV, time to HAART initiation, or HAART response. However, low educational attainment substantially increased lifestyle-related mortality, which indicates that increased mortality in HIV-infected patients with low educational attainments stems from risk factors unrelated to HIV.
评估1998 - 2009年丹麦教育程度与艾滋病毒诊断风险、高效抗逆转录病毒治疗（HAART）反应、全因死亡率及特定病因死亡率之间的关联。
基于人群的前瞻性队列研究，纳入丹麦艾滋病毒队列研究中1277例无丙型肝炎病毒感染或静脉药物滥用的新发艾滋病毒感染患者以及5108例个体匹配的人群对照。
在丹麦教育程度登记处确定教育程度数据，分为低、中、高三个类别。采用逻辑回归和泊松回归来估计比值比（OR）和死亡率比（MRR）。
教育程度低的异性恋个体中，艾滋病毒诊断的OR为1.7（95%置信区间，CI 1.3 - 2.3），但未发现教育程度与开始HAART的时间、CD4细胞计数或病毒抑制之间存在关联。与中等和高等教育程度相比，教育程度低的艾滋病毒感染患者和人群对照的全因MRR分别为1.8（95% CI 1.0 - 3.2）和1.8（1.1 - 2.8）。与中等和高等教育程度相比，教育程度低的艾滋病毒感染患者因吸烟和酒精相关死亡的MRR为3.6（95% CI 1.5 - 8.9），人群对照为2.0（95% CI 1.2 - 3.4）。
在免费且平等获得医疗保健的情况下，教育程度低可能会增加异性恋个体感染艾滋病毒的风险，但与艾滋病毒的晚期/极晚期表现、开始HAART的时间或HAART反应无关。然而，教育程度低会大幅增加与生活方式相关的死亡率，这表明教育程度低的艾滋病毒感染患者死亡率增加源于与艾滋病毒无关的风险因素。
