Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA.
Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
AIDS Res Hum Retroviruses. 2022 Jul;38(7):530-537. doi: 10.1089/AID.2021.0162. Epub 2022 Feb 2.
Geographic location was a strong predictor of falls among women with and without HIV in the Women's Interagency HIV Study. We examined regional variation in falls in a more geographically diverse cohort of older people with HIV (PWH) and explored whether physical activity, sex, or body-mass index modified these associations. PWH enrolled in the A5322 HAILO (HIV Infection, Aging, and Immune Function Long-Term Observational Study). Participants who reported falls in the 6 months before each semiannual visit and had ≥1 consecutive pair of fall assessments were included. We examined associations of geographic region [Northeast, Midwest, South, and West] with recurrent falls (≥2) over each 12-month period using repeated measures multinomial logistic regression models and assessed effect modification by adding an interaction term between geographic region and each potential effect modifier. A total of 788 men and 192 women with median age of 51 years at study entry contributed up to 240 weeks of data. U.S. regions included Northeast (22%), Midwest (29%), South (20%), and West (28%). In multivariable analyses, compared with the Western region, greater risk was seen among Midwestern (odds ratio [OR] = 2.35 [95% confidence interval (CI) = 1.29-4.28]) and Southern regions (OR = 2.09 [95% CI = 1.09-4.01]). Among those with higher physical activity, the Midwestern region had higher odds of recurrent falls than the Western region. Among obese individuals, the Southern region had higher odds of recurrent falls than the Western region. Sex did not modify the association between region and recurrent falls. Among older PWH, fall risk varied by geographic region. Associations between geographic region and recurrent falls appeared to be modified by physical activity and obesity. This may help identify subgroups of older PWH for targeted fall screening/interventions.
地理位置是影响女性艾滋病病毒感染者和非感染者跌倒的重要预测因素。在这项研究中，我们调查了在一个地理区域更为多样化的老年艾滋病病毒感染者队列中，区域差异对跌倒的影响，并探讨了身体活动、性别或体重指数是否会改变这些关联。研究对象为参加 A5322 HAILO（HIV 感染、老龄化和免疫功能长期观察研究）的艾滋病病毒感染者。在每次半年一次的就诊前 6 个月内报告跌倒且有至少连续两次跌倒评估的参与者被纳入研究。我们使用重复测量多项逻辑回归模型，分析地理区域[东北部、中西部、南部和西部]与每 12 个月内多次发生跌倒（≥2 次）之间的关系，并通过在每个潜在的效应修饰因子和地理区域之间添加交互项，评估效应修饰。共有 788 名男性和 192 名女性入组，中位年龄为 51 岁，研究期间共提供了 240 周的数据。研究对象来自美国东北部（22%）、中西部（29%）、南部（20%）和西部（28%）。多变量分析显示，与西部地区相比，中东部地区的风险更高（优势比[OR] = 2.35 [95%置信区间（CI）= 1.29-4.28]），南部地区的风险更高（OR = 2.09 [95% CI = 1.09-4.01]）。在身体活动水平较高的人群中，中东部地区发生多次跌倒的风险高于西部地区。在肥胖人群中，南部地区发生多次跌倒的风险高于西部地区。性别不能改变区域与多次跌倒之间的关联。在老年艾滋病病毒感染者中，跌倒风险因地理区域而异。地理区域与多次跌倒之间的关联似乎受到身体活动和肥胖的影响。这可能有助于确定需要进行有针对性的跌倒筛查/干预的老年艾滋病病毒感染者亚组。
