Baillargeon Jacques, Pulvino John S, Leonardson Jane E, Linthicum Lannette C, Williams Brie, Penn Joseph, Williams Robert S, Baillargeon Gwen, Murray Owen J
1 Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA.
2 Correctional Managed Care Division, University of Texas Medical Branch, Galveston, TX, USA.
Int J STD AIDS. 2017 Nov;28(13):1335-1340. doi: 10.1177/0956462417705530. Epub 2017 Apr 27.
Although the rate of HIV infection among US prison inmates is considerably higher than that of the general population, little is known about age-related changes in HIV-infected inmates over the last decade. This study of the nation's largest state prison system examined (1) whether the mean age of the HIV-infected inmate increased over the last decade, and (2) whether the prevalence of HIV and associated comorbidities varied according to age. The study population included all 230,103 inmates incarcerated in the Texas prison system for any duration during 2014. A separate analysis was conducted on all HIV-infected inmates incarcerated between 2004 and 2014. Information on medical conditions and demographic factors was obtained from an institution-wide electronic medical record system. From 2004 to 2014, the mean age of HIV-infected inmates in the prison system increased from 39.3 to 42.5 years, compared to an increase of 36.1-37.9 for all Texas prison inmates. Multivariable logistic regression was used to assess the independent contributions of multiple demographic and clinical covariates in predicting the binary outcome, HIV infection. The model showed that, in 2014, HIV infection was elevated in inmates who were aged 40-49 years (OR = 3.1; 95% CI 2.7-3.3), aged 50-59 years (OR = 2.4; 95% CI 2.1-2.7), African American (OR = 3.0; 95% CI 2.8-3.3), and in those with several chronic diseases, including chronic obstructive pulmonary disease (OR = 1.7; 95% CI 1.5-1.9), hepatitis C (OR = 2.7; 95% CI 2.5-3.1), major depressive disorder (OR = 1.7; 95% CI 1.5-2.1), bipolar disorder (OR = 2.3; 95% CI 1.8-2.8), and schizophrenia (OR = 1.5; 95% CI 1.3-1.8). Among HIV-infected inmates (n = 2960), the percentage with comorbid disease increased in a linear fashion according to age (p < .01). Correctional health systems must adapt to address the evolving epidemiology of HIV among inmate populations.
尽管美国监狱囚犯中的艾滋病毒感染率远高于普通人群，但对于过去十年中感染艾滋病毒囚犯的年龄相关变化却知之甚少。这项对美国最大的州监狱系统进行的研究考察了：（1）在过去十年中，感染艾滋病毒囚犯的平均年龄是否有所增加；（2）艾滋病毒及相关合并症的患病率是否因年龄而异。研究人群包括2014年期间在德克萨斯州监狱系统中被监禁过任何时长的所有230,103名囚犯。对2004年至2014年期间被监禁的所有感染艾滋病毒的囚犯进行了单独分析。有关医疗状况和人口统计学因素的信息来自全机构范围的电子病历系统。从2004年到2014年，监狱系统中感染艾滋病毒囚犯的平均年龄从39.3岁增加到42.5岁，而德克萨斯州所有监狱囚犯的平均年龄增幅为36.1 - 37.9岁。多变量逻辑回归用于评估多种人口统计学和临床协变量在预测二元结局即艾滋病毒感染方面的独立作用。该模型显示，在2014年，40 - 49岁的囚犯（比值比[OR] = 3.1；95%置信区间[CI] 2.7 - 3.3）、50 - 59岁的囚犯（OR = 2.4；95% CI 2.1 - 2.7）、非裔美国人（OR = 3.0；95% CI 2.8 - 3.3）以及患有多种慢性病的囚犯，包括慢性阻塞性肺疾病（OR = 1.7；95% CI 1.5 - 1.9）、丙型肝炎（OR = 2.7；95% CI 2.5 - 3.1）、重度抑郁症（OR = 1.7；95% CI 1.5 - 2.1）、双相情感障碍（OR = 2.3；95% CI 1.8 - 2.8）和精神分裂症（OR = 1.5；95% CI 1.3 - 1.8）的艾滋病毒感染率升高。在感染艾滋病毒的囚犯（n = 2960）中，合并症的百分比随年龄呈线性增加（p <.01）。惩教卫生系统必须做出调整，以应对囚犯群体中不断变化的艾滋病毒流行病学情况。
