Department of Health Services, Magnuson Health Sciences Center, University of Washington School of Public Health, 1959 NE Pacific St, Box 357660, Seattle, WA, 98195-7660, USA.
VA Health Services Research and Development (HSRD) Denver Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, 1660 S. Columbian Way, Mailstop S-152, Seattle, WA, 98108, USA.
Addict Sci Clin Pract. 2018 Jan 22;13(1):2. doi: 10.1186/s13722-017-0103-z.
Increasing alcohol use is associated with increased risk of mortality among patients living with HIV (PLWH). This association varies by race/ethnicity among general outpatients, but racial/ethnic variation has not been investigated among PLWH, among whom racial/ethnic minorities are disproportionately represented.
VA electronic health record data from the Veterans Aging Cohort Study (2008-2012) were used to describe and compare mortality rates across race/ethnicity and levels of alcohol use defined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. Within each racial/ethnic group, Cox proportional hazards models, adjusted for age, disease severity, and comorbidities, compared mortality risk for moderate-risk (AUDIT-C = 4-7) and high-risk (AUDIT-C ≥ 8) relative to lower-risk (AUDIT-C = 1-3) alcohol use.
Mean follow-up time among black (n = 8518), Hispanic (n = 1353), and white (n = 7368) male PLWH with documented AUDIT-C screening (n = 17,239) was 4.3 years. Black PLWH had the highest mortality rate among patients reporting lower-risk alcohol use (2.9/100 person-years) relative to Hispanic and white PLWH (1.8 and 2.3, respectively) (p value for overall comparison = 0.011). Mortality risk was increased for patients reporting high-risk relative to lower-risk alcohol use in all racial/ethnic groups [black adjusted hazard ratio (AHR) = 1.36, 95% confidence interval (CI) 1.12-1.66; Hispanic AHR = 2.18, 95% CI 1.30-3.64; and white AHR = 2.04, 95% CI 1.61-2.58]. For only white PLWH, mortality risk was increased for patients reporting moderate-relative to lower-risk alcohol use (black AHR = 1.09, 95% CI 0.93-1.27; Hispanic AHR = 1.36, 95% CI 0.89-2.09; white AHR = 1.51, 95% CI 1.28-1.77).
Among all PLWH, mortality risk was increased among patients reporting high-risk alcohol use across all racial/ethnic groups, but mortality risk was only increased among patients reporting moderate-risk relative to lower-risk alcohol use among white PLWH, and black patients appeared to have higher mortality risk relative to white patients at lower-risk levels of alcohol use. Findings of the present study further underscore the need to address unhealthy alcohol use among PLWH, and future research is needed to understand mechanisms underlying observed differences.
在感染 HIV（PLWH）的患者中，饮酒量增加与死亡率增加相关。这种关联在普通门诊患者的不同种族/民族中有所不同，但在 PLWH 中尚未进行种族/民族差异的研究，其中少数民族的比例不成比例。
使用退伍军人老龄化队列研究（2008-2012 年）的 VA 电子健康记录数据，描述并比较了按酒精使用障碍识别测试-摄入量（AUDIT-C）问卷定义的种族/民族和酒精使用水平的死亡率。在每个种族/民族群体内，使用 Cox 比例风险模型，调整年龄、疾病严重程度和合并症，比较了中危（AUDIT-C=4-7）和高危（AUDIT-C≥8）饮酒与低危（AUDIT-C=1-3）饮酒的死亡率风险。
在记录有 AUDIT-C 筛查的黑人（n=8518）、西班牙裔（n=1353）和白人（n=7368）男性 PLWH 中，平均随访时间为 4.3 年（n=17239）。与西班牙裔和白人 PLWH 相比，报告低危酒精使用的黑人 PLWH 的死亡率最高（2.9/100 人年）（总体比较的 p 值=0.011）。在所有种族/民族群体中，与低危酒精使用相比，报告高危酒精使用的患者死亡率风险增加[黑人调整后的危险比（AHR）=1.36，95%置信区间（CI）为 1.12-1.66；西班牙裔 AHR=2.18，95%CI 为 1.30-3.64；白人 AHR=2.04，95%CI 为 1.61-2.58]。仅对白人 PLWH 而言，与低危酒精使用相比，报告中危酒精使用的患者死亡率风险增加（黑人 AHR=1.09，95%CI 为 0.93-1.27；西班牙裔 AHR=1.36，95%CI 为 0.89-2.09；白人 AHR=1.51，95%CI 为 1.28-1.77）。
在所有 PLWH 中，报告高危酒精使用的患者死亡率风险在所有种族/民族群体中均增加，但仅在白人 PLWH 中，与低危酒精使用相比，报告中危酒精使用的患者死亡率风险增加，且黑人患者在低危酒精使用水平下的死亡率风险似乎高于白人患者。本研究的结果进一步强调了需要解决 PLWH 中不健康的酒精使用问题，需要进一步研究来了解观察到的差异的机制。
