Department of Population H, Hofstra University, 106 Hofstra Dome, Hempstead, NY 11549, United States.
Department of Epidemiology and Biostatistics, Texas AandM University, 212 Adriance Lab Rd., College Station, TX 77843-1266, United States.
Arch Gerontol Geriatr. 2023 Jun;109:104950. doi: 10.1016/j.archger.2023.104950. Epub 2023 Jan 29.
Despite the progress made in managing HIV, the mortality trends among older adults in the US remains understudied. The lack of evidence in this demographic hampers the ability to implement evidence-based interventions. Our aim is to analyze the trends in HIV-related mortality among US citizens aged 65 years and above by demographic characteristics such as age, gender, race/ethnicity, and census region.
We abstracted national mortality data from the underlying cause of death files in the CDC WONDER database. The ICD-10 Codes- B20-B24 were used to identify HIV deaths among US older adults from 1999 to 2020. Trends in age-adjusted mortality rate (AAMR) were assessed using a five-year simple moving average and Joinpoint analysis. Results were expressed as annual percentage changes (APC), average annual percentage changes, and 95% confidence intervals (CI).
Between 1999 and 2020, a total of 15,694 older adults died from HIV in the US (AAMR= 1.7 per 100,000; 95% CI: 1.6 - 1.7). Overall mortality trends increased at an annual rate of 1.5% (95% CI: 1.2, 1.8) from 1999 through 2020. The trends increased among Non-Hispanic Whites, stabilized among Non-Hispanic Blacks, and decreased among Hispanics from 1999 to 2020. Further, the trends increased consistently across categories of age (65 to 74 years; 75 to 84 years), sex, and census region.
HIV mortality among older adults in the US has risen overall from 1999 to 2020, but with varying trends by race and ethnicity. This highlights the need for enhanced public health surveillance to better understand the scope of HIV mortality among older adults and identify high-risk demographic and regional subgroups for targeted interventions. Improving timely diagnosis, managing comorbidities, and stigma surrounding HIV among older adults are crucial to reducing HIV mortality in this population.
尽管在管理 HIV 方面取得了进展，但美国老年人群体的死亡率趋势仍研究不足。这一人群缺乏证据，阻碍了实施基于证据的干预措施的能力。我们的目的是分析美国 65 岁及以上公民按年龄、性别、种族/族裔和普查区域等人口统计学特征的 HIV 相关死亡率趋势。
我们从疾病预防控制中心 WONDER 数据库的根本死因文件中提取了全国死亡率数据。ICD-10 代码 B20-B24 用于识别 1999 年至 2020 年美国老年人群中的 HIV 死亡。使用五年简单移动平均和 Joinpoint 分析评估年龄调整死亡率（AAMR）的趋势。结果表示为年百分比变化（APC）、平均年百分比变化和 95%置信区间（CI）。
1999 年至 2020 年间，美国共有 15694 名老年人死于 HIV（AAMR=1.7/10 万；95%CI：1.6-1.7）。总体死亡率趋势从 1999 年至 2020 年以每年 1.5%的速度增长（95%CI：1.2，1.8）。非西班牙裔白人的趋势增加，非西班牙裔黑人和西班牙裔的趋势稳定，从 1999 年至 2020 年下降。此外，各年龄段（65 至 74 岁；75 至 84 岁）、性别和普查区域的趋势一致增加。
1999 年至 2020 年，美国老年人群中的 HIV 死亡率总体呈上升趋势，但按种族和族裔的趋势不同。这突出表明需要加强公共卫生监测，以更好地了解老年人群中 HIV 死亡率的范围，并确定针对特定干预措施的高风险人口统计学和地区亚组。改善老年人群中 HIV 的及时诊断、管理合并症和消除耻辱感对于降低该人群的 HIV 死亡率至关重要。
