Trepka Mary Jo, Fennie Kristopher P, Sheehan Diana M, Niyonsenga Theophile, Lieb Spencer, Maddox Lorene M
Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami.
Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami.
Ann Epidemiol. 2016 Mar;26(3):176-82.e1. doi: 10.1016/j.annepidem.2016.02.002. Epub 2016 Feb 16.
We compared all-cause and human immunodeficiency virus (HIV) mortality in a population-based, HIV-infected cohort.
Using records of people diagnosed with HIV during 2000-2009 from the Florida Enhanced HIV-acquired immunodeficiency syndrome (AIDS) Reporting System, we conducted a proportional hazards analysis for all-cause mortality and a competing risk analysis for HIV mortality through 2011 controlling for individual-level factors, neighborhood poverty, and rural-urban status and stratifying by concurrent AIDS status (AIDS within 3 months of HIV diagnosis).
Of 59,880 HIV-infected people, 32.2% had concurrent AIDS and 19.3% died. Adjusting for period of diagnosis, age group, sex, country of birth, HIV transmission mode, area-level poverty, and rural-urban status, non-Hispanic black (NHB) and Hispanic people had an elevated adjusted hazards ratio (aHR) for HIV mortality relative to non-Hispanic whites (NHB concurrent AIDS: aHR 1.34, 95% confidence interval [CI], 1.23-1.47; NHB without concurrent AIDS: aHR 1.41, 95% CI 1.26-1.57; Hispanic concurrent AIDS: aHR 1.18, 95% CI 1.05-1.32; Hispanic without concurrent AIDS: aHR 1.18, 95% CI 1.03-1.36).
Considering competing causes of death, NHB and Hispanic people had a higher risk of HIV mortality even among those without concurrent AIDS, indicating a need to identify and address barriers to HIV care in these populations.
我们在一个基于人群的HIV感染队列中比较了全因死亡率和人类免疫缺陷病毒（HIV）死亡率。
利用佛罗里达强化HIV获得性免疫缺陷综合征（AIDS）报告系统中2000年至2009年期间被诊断为HIV的人员记录，我们对全因死亡率进行了比例风险分析，并对截至2011年的HIV死亡率进行了竞争风险分析，控制了个体层面因素、邻里贫困和城乡状况，并按同期AIDS状况（HIV诊断后3个月内出现AIDS）进行分层。
在59880名HIV感染者中，32.2%患有同期AIDS，19.3%死亡。在调整了诊断时间、年龄组、性别、出生国家、HIV传播方式、地区层面贫困和城乡状况后，非西班牙裔黑人（NHB）和西班牙裔人群相对于非西班牙裔白人的HIV死亡调整后风险比（aHR）升高（NHB同期AIDS：aHR 1.34，95%置信区间[CI]，1.23 - 1.47；NHB无同期AIDS：aHR 1.41，95% CI 1.26 - 1.57；西班牙裔同期AIDS：aHR 1.18，95% CI 1.05 - 1.32；西班牙裔无同期AIDS：aHR 1.18，95% CI 1.03 - 1.36）。
考虑到死亡的竞争原因，即使在没有同期AIDS的人群中，NHB和西班牙裔人群的HIV死亡风险也更高，这表明需要识别并解决这些人群中HIV护理的障碍。
