British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Can J Public Health. 2021 Dec;112(6):1030-1041. doi: 10.17269/s41997-021-00525-4. Epub 2021 Aug 30.
Longer survival has increased the likelihood of antiretroviral-treated people living with HIV (PLWH) developing age-associated comorbidities. We compared the burden of multimorbidity and all-cause mortality across HIV status in British Columbia (BC), and assessed the longitudinal effect of multimorbidity on all-cause mortality among PLWH.
Antiretroviral-treated PLWH aged ≥19 years and 1:4 age-sex-matched HIV-negative individuals from a population-based cohort were followed for ≥1 year during 2001-2012. Diagnoses of seven age-associated comorbidities were identified from provincial administrative databases and grouped into 0, 1, 2, and ≥3 comorbidities. Multimorbidity prevalence and age-standardized mortality rates (ASMRs) in both populations were stratified by BC's health regions. Marginal structural models were used to estimate the effect of multimorbidity on mortality among PLWH, adjusted for time-varying confounders affected by prior multimorbidity.
Among 8031 PLWH and 32,124 HIV-negative individuals, 25% versus 11% developed multimorbidity, and 23.53 deaths/1000 person-years (95% confidence interval [95% CI]: 22.02-25.13) versus 3.04 (2.81-3.29) were observed, respectively. PLWH in Northern region had the highest ASMR, but those in South Vancouver Island experienced the greatest difference in mortality compared with HIV-negative individuals. Among PLWH, compared with those with zero comorbidities, adjusted hazard ratios for those with 1, 2, and ≥3 comorbidities were 3.36 (95% CI: 2.86-3.95), 6.92 (5.75-8.33), and 12.87 (10.45-15.85), respectively.
PLWH across BC's health regions experience excess multimorbidity and associated mortality. We highlight health disparities which are key when planning the distribution of healthcare resources across BC, and provide evidence for improved HIV care models integrating prevention and management of chronic diseases.
随着抗逆转录病毒治疗（ART）患者存活时间的延长，HIV 感染者（PLWH）出现与年龄相关的合并症的可能性增加。本研究比较了不列颠哥伦比亚省（BC）的 HIV 状态与多种合并症负担和全因死亡率之间的关系，并评估了多种合并症对 PLWH 全因死亡率的纵向影响。
本研究纳入了一个基于人群的队列中年龄≥19 岁且接受 ART 治疗的 PLWH 以及年龄和性别相匹配的 1:4 的 HIV 阴性个体，在 2001 年至 2012 年期间随访时间≥1 年。从省级行政数据库中确定了七种与年龄相关的合并症诊断，并将其分为 0、1、2 和≥3 种合并症。在 BC 的卫生区域中，对两个群体的多种合并症患病率和年龄标准化死亡率（ASMR）进行分层。使用边缘结构模型估计多种合并症对 PLWH 死亡率的影响，调整了受先前多种合并症影响的时变混杂因素。
在 8031 名 PLWH 和 32124 名 HIV 阴性个体中，分别有 25%和 11%的患者发生了多种合并症，全因死亡率分别为 23.53 例/1000 人年（95%置信区间[95%CI]：22.02-25.13）和 3.04 例/1000 人年（2.81-3.29）。北部地区的 PLWH 具有最高的 ASMR，但与 HIV 阴性个体相比，温哥华岛南部地区的死亡率差异最大。在 PLWH 中，与无合并症的患者相比，有 1、2 和≥3 种合并症的患者的调整后危险比分别为 3.36（95%CI：2.86-3.95）、6.92（5.75-8.33）和 12.87（10.45-15.85）。
BC 各卫生区域的 PLWH 存在多种合并症和相关死亡率过高的问题。我们强调了健康差异，这在规划 BC 医疗资源的分配时非常关键，并为改善整合预防和管理慢性疾病的 HIV 护理模式提供了证据。
