Seage G R, Oddleifson S, Carr E, Shea B, Makarewicz-Robert L, van Beuzekom M, De Maria A
Institute for Urban Health Policy, Research and Education, Boston Department of Health and Hospitals, MA 02118.
Am J Public Health. 1993 Jan;83(1):72-8. doi: 10.2105/ajph.83.1.72.
The goal of the study was to determine survival time after diagnosis of acquired immunodeficiency syndrome (AIDS) and to identify predictors of survival.
We conducted a population-based prospective survival analysis of all Massachusetts-resident adult AIDS patients diagnosed from January 1, 1979, through December 31, 1988.
Median survival was 406 days, with a 5-year survival rate of 3%. Age older than 40 years (P = .001), a diagnosis other than Kaposi's sarcoma (P = .001), and a history of intravenous drug use (P < or = .01) were associated with shorter survival after confounding was controlled. Survival increased as year of diagnosis became more recent (P < .0001). This temporal effect was strongest for patients with Pneumocystis carinii pneumonia. Individuals with Kaposi's sarcoma, Hispanics, homosexual men who were concurrent intravenous drug users, and residents of the greater Boston standard metropolitan statistical area, excluding the city of Boston, did not experience increases in survival over time.
With the exception of cases initially defined by Kaposi's sarcoma, recently diagnosed AIDS case subjects survive longer than those diagnosed earlier in the epidemic. Further work is needed to determine whether this effect is due to lead-time bias or better treatment after diagnosis.
本研究的目的是确定获得性免疫缺陷综合征（艾滋病）诊断后的生存时间，并确定生存的预测因素。
我们对1979年1月1日至1988年12月31日期间确诊的所有马萨诸塞州成年艾滋病患者进行了基于人群的前瞻性生存分析。
中位生存期为406天，5年生存率为3%。年龄大于40岁（P = .001）、非卡波西肉瘤诊断（P = .001）以及静脉吸毒史（P ≤ .01）在控制混杂因素后与较短生存期相关。随着诊断年份越近，生存率增加（P < .0001）。这种时间效应在卡氏肺孢子虫肺炎患者中最为明显。患有卡波西肉瘤的个体、西班牙裔、同时为静脉吸毒者的同性恋男性以及大波士顿标准都市统计区（不包括波士顿市）的居民，其生存率并未随时间增加。
除最初由卡波西肉瘤定义的病例外，近期诊断的艾滋病病例患者比在疫情早期诊断的患者生存时间更长。需要进一步研究以确定这种效应是由于领先时间偏倚还是诊断后更好的治疗。
