Lancet HIV. 2015 Dec;2(12):e540-9. doi: 10.1016/S2352-3018(15)00203-9. Epub 2015 Nov 18.
Many migrants face adverse socioeconomic conditions and barriers to health services that can impair timely HIV diagnosis and access to life-saving treatments. We aimed to assess the differences in overall mortality by geographical origin in HIV-positive men and women using data from COHERE, a large European collaboration of HIV cohorts from 1997 to 2013.
In this observational cohort study, we included HIV-positive, antiretroviral-naive people accessing care in western Europe from COHERE. Individuals were eligible if enrolled in a cohort that collected information on geographical origin or ethnic origin from Jan 1, 1997, to March 19, 2013, aged 18-75 years, they had available information about sex, they were not infected perinatally or after the receipt of clotting factor concentrates, and were naive to combination antiretroviral therapy at cohort entry. Migrants' origins were grouped into seven regions: western Europe and similar countries (Australia, Canada, New Zealand, and the USA); eastern Europe; North Africa and the Middle East; sub-Saharan Africa; Latin America; the Caribbean; and Asia and the rest of Oceania (excluding Australia and New Zealand). Crude and adjusted mortality rate ratios were calculated by use of Poisson regression stratified by sex, comparing each group with the native population. Multiple imputation with chained equations was used to account for missing values.
Between Oct 25, 1979, and March 19, 2013, we recruited 279 659 individuals to the COHERE collaboration in EuroCoord. Of these 123 344 men and 45 877 women met the inclusion criteria. Our data suggested effect modification by transmission route (pinteraction=0·12 for men; pinteraction=0·002 for women). No significant difference in mortality was identified by geographical origin in men who have sex with men. In heterosexual populations, most migrant men had mortality lower than or equal to that of native men, whereas no group of migrant women had mortality lower than that in native women. High mortality was identified in heterosexual men from Latin America (rate ratio [RR] 1·46, 95% CI 1·00-2·12, p=0·049) and heterosexual women from the Caribbean (1·48, 1·29-1·70, p<0·0001). Compared with that in the native population, mortality in injecting drug users was similar or low for all migrant groups.
Characteristics of and risks faced by migrant populations with HIV differ for men and women and for populations infected heterosexually, by sex between men, or by injecting drug use. Further research is needed to understand how inequalities are generated and maintained for the groups with higher mortality identified in this study.
EuroCoord.
许多移民面临不利的社会经济条件和获得卫生服务的障碍，这可能会影响艾滋病毒的及时诊断和获得救命治疗。我们旨在使用来自 COHERE 的欧洲大型艾滋病毒队列合作的数据，评估艾滋病毒阳性男性和女性按原籍地划分的总体死亡率差异。
在这项观察性队列研究中，我们纳入了在西欧接受 COHERE 护理的艾滋病毒阳性、初治人群。符合条件的个体包括：1997 年 1 月 1 日至 2013 年 3 月 19 日期间，在收集原籍地或族裔信息的队列中登记，年龄 18-75 岁；有性别相关信息；非围产期或输注凝血因子浓缩物后感染；初治时未接受联合抗逆转录病毒治疗。移民来源分为七个地区：西欧和类似国家（澳大利亚、加拿大、新西兰和美国）；东欧；北非和中东；撒哈拉以南非洲；拉丁美洲；加勒比地区；以及亚洲和大洋洲其他地区（不包括澳大利亚和新西兰）。使用泊松回归按性别分层，计算每个群体与本地人群相比的粗死亡率和校正死亡率比值。使用链式方程进行多重插补，以处理缺失值。
1979 年 10 月 25 日至 2013 年 3 月 19 日，我们在 EuroCoord 合作的 COHERE 中招募了 279659 人。其中 123344 名男性和 45877 名女性符合纳入标准。我们的数据表明，传播途径存在效应修饰（p 交互=0·12 男性；p 交互=0·002 女性）。在男男性接触者中，原籍地对死亡率没有显著影响。在异性恋人群中，大多数移民男性的死亡率与本地男性相同或更低，而没有一个移民女性群体的死亡率低于本地女性。拉丁美洲的异性恋男性（RR 1·46，95%CI 1·00-2·12，p=0·049）和加勒比地区的异性恋女性（1·48，1·29-1·70，p<0·0001）的死亡率较高。与本地人群相比，所有移民群体的注射吸毒者的死亡率相似或较低。
感染艾滋病毒的移民人群的特征和面临的风险因性别、男男性接触者的性别、注射吸毒者而异。需要进一步研究以了解如何为研究中死亡率较高的群体产生和维持不平等。
EuroCoord。
