Office of Biostatistics, Department of Preventive Medicine and Population Health.
Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston.
AIDS. 2021 Aug 1;35(10):1667-1675. doi: 10.1097/QAD.0000000000002963.
People with HIV infection experience excessive mortality compared with their noninfected counterparts. It is unclear whether the impact of HIV infection on mortality varies by comorbidities or whether sex difference exists in this relationship. This study assessed the effect of newly diagnosed HIV infection on overall mortality among Medicare beneficiaries for both disabled and older adults (≥65 years old) based on their original entitlement.
We constructed a retrospective matched cohort using a 5% nationally representative sample of Medicare beneficiaries between 1996 and 2015. People with incident HIV diagnoses were individually matched to up to three controls based on demographics. Cox proportional hazards models adjusted for baseline demographics and comorbidities were used to assess the effect of HIV status on survival among four disabled groups by sex strata. Within each stratum, interactions between comorbidity variables and HIV status were examined.
People with HIV, especially older women, had a higher prevalence of baseline comorbidities than controls. HIV--mortality association varied according to sex in older adults (P = 0.004). Comorbidity--HIV interactions were more pronounced in disabled groups (P < 0.0001). People with HIV with more chronic conditions had a less pronounced increase in the risk of death than those with fewer conditions, compared with uninfected controls.
Medicare enrollees with newly diagnosed HIV had more prevalent baseline comorbidities and were at higher risk of death than people without HIV. HIV infection has a more pronounced effect among those with fewer comorbidities. Sex differences in HIV--mortality association exist among older Medicare enrollees.
与未感染人群相比，HIV 感染者的死亡率过高。尚不清楚 HIV 感染对死亡率的影响是否因合并症而有所不同，或者这种关系是否存在性别差异。本研究评估了根据原始权益，在残疾和老年人（≥65 岁）的 Medicare 受惠人中，新发 HIV 感染对总体死亡率的影响。
我们使用了 1996 年至 2015 年期间 Medicare 受惠者的 5%全国代表性样本，构建了一个回顾性匹配队列。根据人口统计学数据，对每例新发 HIV 感染者进行了最多三人的对照匹配。采用 Cox 比例风险模型，根据基线人口统计学数据和合并症对生存情况进行了调整，以评估 HIV 状态对四个残疾组的性别分层的影响。在每个分层中，都检查了合并症变量与 HIV 状态之间的相互作用。
与对照组相比，HIV 感染者，尤其是老年女性，其基线合并症的患病率更高。在老年人中，HIV-死亡率的相关性因性别而异（P=0.004）。在残疾组中，合并症与 HIV 之间的相互作用更为显著（P<0.0001）。与未感染对照组相比，合并症更多的 HIV 感染者的死亡风险增加幅度较小。
新诊断出 HIV 的 Medicare 参保者具有更高的基线合并症患病率，其死亡风险高于未感染 HIV 的人群。HIV 感染对合并症较少的人群影响更为显著。在老年 Medicare 参保者中，HIV-死亡率的相关性存在性别差异。
