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Ehlers LH, Axelsen F, Bøjer Rasmussen T, Dollerup J, Jespersen NA, Larsen CS, Nørgaard M. Cost of non‐communicable diseases in people living with
HIV
in the Central Denmark Region. HIV Med 2022; 24:453-461. [PMID: 36274224 DOI: 10.1111/hiv.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/15/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To estimate the economic burden of non-communicable diseases (NCDs) in people living with HIV (PLWH) in Denmark. METHODS We conducted a cohort study using population-based Danish medical registries including all adult residents of the Central Denmark Region registered with a first-time HIV-diagnosis during the period 2006-2017. For each PLWH, we matched 10 persons without HIV from the background population by birth year, sex and municipality of residence. Information on healthcare utilization and costs for the PLWH and non-HIV cohorts was retrieved from register data. For each cohort, we estimated the annual costs for major disease categories (HIV care, other somatic care, and psychiatric care) in the period from 3 years before to 9 years after diagnosis/matching date. RESULTS We identified 407 PLWH and 4070 persons from the background population. The total healthcare costs during the study period were approximately three times higher for PLWH compared to the non-HIV cohort (€76 198 vs. €23 692). Average annual cost of hospital care, primary care and selected prescription medicine was estimated to be €6987 per year in the years after the diagnosis compared to €2083 per year in the non-HIV cohort. In PLWH, the cost of NCDs and psychiatric care was approximately two times higher than the cost of HIV care. CONCLUSION PLWH have higher healthcare costs stemming from three areas: excess cost due to the HIV infection, the treatment of NCDs, and psychiatric care.
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Affiliation(s)
| | | | - Thomas Bøjer Rasmussen
- Department of Clinical Epidemiology and Department of Medicine Aarhus University Hospital, Aarhus University Aarhus Denmark
| | - Jens Dollerup
- Department of Clinical Epidemiology and Department of Medicine Aarhus University Hospital, Aarhus University Aarhus Denmark
| | | | | | - Mette Nørgaard
- Department of Clinical Epidemiology and Department of Medicine Aarhus University Hospital, Aarhus University Aarhus Denmark
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Carlander C, Wagner P, Yilmaz A, Sparén P, Svedhem V. Employment by HIV status, mode of HIV transmission and migrant status: a nation-wide population-based study. AIDS 2021; 35:115-123. [PMID: 33048876 DOI: 10.1097/qad.0000000000002724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare employment in people by HIV status, mode of HIV transmission and migrant status. DESIGN Nation-wide population-based register data from 1996 to 2016. METHODS All people born between 1940 and 2000 (n = 8587 629) were identified from the Swedish Total Population Register and linked to the Swedish National HIV Register (n = 9492) and Longitudinal Integration Database for Health Insurance and Labour Market Studies. Adjusted prevalence ratios (adjPR) of employment were calculated using Poisson regression. Trends in employment were illustrated in scatterplots with overlaid prediction plots. RESULTS People with HIV were less likely employed than HIV-negative but with decreasing difference over time [adjPR 0.57, 95% confidence interval (CI) 0.54-0.60 in 1996, adjPR 0.84, 95% CI 0.83-0.86 in 2016]. Female migrants with HIV had the highest increase of employment over time and were more likely employed than HIV-negative female migrants by end of follow-up (adjPR 1.12, 95% CI 1.08-1.16). Swedish-born with present/former intravenous drug use had the lowest employment rates. Individuals with undetectable HIV-RNA viral levels showed higher employment rates (adjPR 1.29, 95% CI 1.20-1.38) compared with those with detectable viral levels. CONCLUSION Employment in people living with HIV (PLWH) increased over time but remained lower than for HIV-negative people. HIV was not associated with lower employment in migrants by end of follow-up, indicating that HIV is not a barrier for employment among migrants in Sweden. The heterogeneity of PLWH needs to be taken into account in interventions, and future studies, focusing on access to the labour market in PLWH.
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Affiliation(s)
- Christina Carlander
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
- Centre for Clinical Research, County of Västmanland, Uppsala University, Västerås
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
| | - Philippe Wagner
- Centre for Clinical Research, County of Västmanland, Uppsala University, Västerås
| | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
| | - Veronica Svedhem
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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3
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Oliveira VHF, Borsari AL, Webel AR, Erlandson KM, Deminice R. Sarcopenia in people living with the Human Immunodeficiency Virus: a systematic review and meta-analysis. Eur J Clin Nutr 2020; 74:1009-1021. [PMID: 32341489 DOI: 10.1038/s41430-020-0637-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 01/05/2023]
Abstract
People living with HIV (PLHIV) experience greater loss of muscle mass and function than people without HIV. However, HIV is not routinely recognized as a sarcopenia risk factor outside of HIV literature. The purposes of this study were to establish the prevalence and predictors of sarcopenia among PLHIV, and to compare the prevalence of sarcopenia among PLHIV and people without HIV. A systematic literature search of the PubMed, Embase, Cinahl, and Scielo databases was performed following PRISMA and MOOSE guidelines. Identified articles were included if they evaluated sarcopenia among PLHIV using either the presence of low muscle mass only or low muscle mass in association with low muscle function. The pooled prevalence of sarcopenia among PLHIV and the odds ratio for sarcopenia in PLHIV compared with controls were calculated. From 13 studies and 2267 participants, the prevalence of sarcopenia among PLHIV was 24.1% (95% CI = 17.8-31.0%). PLHIV presented 6.1 greater odds (95% CI = 1.1-33.5) of sarcopenia compared with people without HIV, matched by age, sex, BMI, and ethnicity. Longer exposure to specific HIV drugs, tobacco and alcohol, lower education and employment rates, and greater HIV duration were associated with sarcopenia. In conclusion, PLHIV had a high prevalence of sarcopenia, related to both HIV and non-HIV risk factors. HIV should be considered a risk factor for sarcopenia in the general population. CRD42019131449.
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Affiliation(s)
- Vitor H F Oliveira
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil.
| | - Ana L Borsari
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Rafael Deminice
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil
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Wang X, Guo G, Zheng J, Lu L. Programmes for the prevention of mother-to-child HIV infection transmission have made progress in Yunnan Province, China, from 2006 to 2015: a cost effective and cost-benefit evaluation. BMC Infect Dis 2019; 19:64. [PMID: 30654744 PMCID: PMC6337853 DOI: 10.1186/s12879-019-3708-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/10/2019] [Indexed: 11/16/2022] Open
Abstract
Background Prevention of mother-to-child transmission (PMTCT) of HIV programmes have substantially reduced HIV infections among infants in Yunnan Province, China. We conducted a macro-level economic evaluation of Yunnan’s PMTCT programmes over the 10 years from 2006 to 2015 from a policymaker perspective. Methods The study methodology was in accordance with the guidelines from the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. We quantified the output from the Yunnan’s PMTCT programmes by estimating the number of paediatric HIV infections averted and the relative savings to both the health care system and society. The return-on-investment ratio (ROI) was calculated as the output (numerator) divided by the input (denominator). Results We have found that the US$ 49 million investment in Yunnan’s PMTCT programmes over the period from 2006 to 2015 averted an estimated 2725 new paediatric HIV infections and resulted in an estimated 134,008 QALY acquired. It saved an estimated US$ 0.5 billion in treatment expenditures for Yunnan’s healthcare system and nearly US$ 3.9 billion in productivity. The ROI was 88.4, meaning every US$ 1 invested brought about US$ 88.4 in benefits. Conclusions Our results support the ongoing investment in PMTCT programmes in Yunnan Province. The PMTCT strategy is a cost effective and cost-benefit strategy in the periods from 2006 to 2015. Despite higher investments in the future, the overall investment in the PMTCT programmes in Yunnan province could be offset by averting more paediatric infections.
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Affiliation(s)
- Xiaowen Wang
- Yunnan Center for Disease Control and Prevention, No.158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China.,Department of Public Health, Kunming Medical University, No. 1168, West Chunrong Road, Yuhua Street, Chenggong District, Kunming, 650599, Yunnan Province, China
| | - Guangping Guo
- Yunnan Maternal and Child Health Care hospital, No. 200, Gulou Road, Wuhua District, Kunming, 650032, Yunnan Province, China
| | - Jiarui Zheng
- Yunnan Maternal and Child Health Care hospital, No. 200, Gulou Road, Wuhua District, Kunming, 650032, Yunnan Province, China
| | - Lin Lu
- Department of Public Health, Kunming Medical University, No. 1168, West Chunrong Road, Yuhua Street, Chenggong District, Kunming, 650599, Yunnan Province, China. .,Health and Family Planning Commission of Yunnan Province, No. 309, Guomao Street, Kunming, 650299, Yunnan Province, China.
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5
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Wagener MN, van Opstal SEM, Miedema HS, van Gorp ECM, Roelofs PDDM. Work-related stigma and disclosure: A daily challenge for people living with HIV. Work 2018; 58:537-548. [PMID: 29254135 DOI: 10.3233/wor-172650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Stigma and disclosure are important work-related issues for people living with HIV (PLWH). To gain better understanding and improve the position of PLWH in the labor market, further insight in these issues is needed. OBJECTIVE This study reviews the scientific evidence related to work-related stigma and disclosure. METHODS A sensitive literature search was performed in the databases of Medline, Embase, Cochrane Library, Cinahl and Psychinfo for articles published between 1996 and 2016. All studies on PLWH in western countries and investigating disclosure or stigma in relation to work were included. RESULTS Of the 866 identified studies, 19 met the inclusion criteria: 4 addressed both disclosure and stigma (2 quantitative), 9 addressed only disclosure (4 quantitative) and 7 studies addressed only stigma (4 quantitative). CONCLUSION This review provides a unique overview of the research on work-related disclosure and stigma, which will enable health care providers to support PWLH to make well-considered decisions. However, the available literature was heterogeneous and in most studies the topics of our interest were secondary outcomes and provided only basic insight.
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Affiliation(s)
- M N Wagener
- Centre of Expertise Innovations in Care, Rotterdam University of Applied Science, The Netherlands
| | - S E M van Opstal
- Centre of Expertise Innovations in Care, Rotterdam University of Applied Science, The Netherlands
| | - H S Miedema
- Centre of Expertise Innovations in Care, Rotterdam University of Applied Science, The Netherlands
| | - E C M van Gorp
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - P D D M Roelofs
- Centre of Expertise Innovations in Care, Rotterdam University of Applied Science, The Netherlands
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van Opstal SEM, van der Zwan JS, Wagener MN, Been SK, Miedema HS, Roelofs PDDM, van Gorp ECM. Late Presentation of HIV Infection in the Netherlands: Reasons for Late Diagnoses and Impact on Vocational Functioning. AIDS Behav 2018; 22:2593-2603. [PMID: 29550940 PMCID: PMC6097719 DOI: 10.1007/s10461-018-2082-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Late diagnosis of HIV remains a major challenge in the HIV epidemic. In Europe, about 50% of all people living with HIV are diagnosed late after infection has occurred. Insight into the reasons for late diagnoses is necessary to increase the number of early diagnoses and optimize treatment options. This qualitative study explored the experiences of 34 late-presenters through in-depth semi-structured interviews. A variety of reasons for late diagnoses emerged from our data and led to a division into four groups, characterized by two dimensions. Regarding vocational functioning, the consequences of late diagnoses were health-related problems prior to and since diagnosis, and problems concealing the HIV status. Healthcare providers should offer HIV tests to groups at risk, and be alert for clinical HIV indicator conditions. It is recommended to increase awareness of HIV transmission routes, symptoms and tests, and the benefits of early testing and early entry to HIV care.
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Affiliation(s)
- S E M van Opstal
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands.
- Erasmus MC, Department of Viroscience, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - J S van der Zwan
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - M N Wagener
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - S K Been
- Erasmus MC, Department of Internal Medicine and Infectious Diseases, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H S Miedema
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - P D D M Roelofs
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - E C M van Gorp
- Erasmus MC, Department of Viroscience, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Hjalte F, Calara PS, Blaxhult A, Helleberg M, Wallace K, Lindgren P. Excess costs of non-infectious comorbidities among people living with HIV - estimates from Denmark and Sweden. AIDS Care 2018; 30:1090-1098. [PMID: 29774749 DOI: 10.1080/09540121.2018.1476661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
People living with HIV have an increased risk of comorbidities with non-communicable diseases such as cardiovascular disease, chronic kidney disease and osteoporotic fractures, compared to the general population. The burden of these comorbidities is expected to rise as the HIV-infected population ages. This development may require additional health care resources and it is relevant to ascertain the costs associated with these comorbidities. The population attributed risk approach was applied to estimate excess costs associated with the higher rates of comorbidities among HIV patients in Denmark and Sweden compared to their respective general populations. Excess direct and indirect costs for one year were calculated for myocardial infarction, stroke, osteoporotic fractures and chronic kidney disease. Cost estimates were presented in age and sex subgroups. In the course of one year the excess costs for myocardial infarction, stroke, osteoporotic fractures and chronic kidney disease attributable to HIV was estimated to €3.4 million for Denmark and €2.6 million for Sweden. Chronic kidney disease accounted for the majority of the total excess costs, followed by osteoporotic fractures, myocardial infarction and stroke. The high prevalence of comorbidities in the HIV-infected population is associated with substantial excess costs. Focus on primary and secondary prophylactic interventions is warranted. Additional studies, preferably large-scale case-control studies, may give further insights on the extent and the predictors of these excess costs.
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Affiliation(s)
- Frida Hjalte
- a The Swedish Institute for Health Economics (IHE) , Lund , Sweden
| | - Paul S Calara
- a The Swedish Institute for Health Economics (IHE) , Lund , Sweden
| | - Anders Blaxhult
- b Department of Infectious Diseases , Venhälsan, Södersjukhuset , Stockholm , Sweden
| | - Marie Helleberg
- c Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | | | - Peter Lindgren
- a The Swedish Institute for Health Economics (IHE) , Lund , Sweden.,e Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden
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8
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Verbooy K, Wagener M, Kaddouri M, Roelofs P, Miedema H, van Gorp E, Brouwer W, van Exel J. Are people living with HIV less productive at work? AIDS Care 2018. [PMID: 29517931 DOI: 10.1080/09540121.2018.1447076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Health problems may cause decreased productivity among working people. It is unclear if this also applies for people living with HIV (PLWH). This cross-sectional study compares data of PLWH of one of the main HIV treatment centres in the Netherlands (n = 298) to data of the general working population from a previously conducted study (n = 986). We investigate whether productivity at work differs between these groups. The questionnaires used in these studies contained a core of identical questions regarding productivity losses, in the form of absenteeism and presenteeism, over a four-week period and a variety of baseline characteristics, including health status measured with EQ-5D. For PLWH additional clinical data were collected from patient records. From the data, descriptive statistics were computed to characterize the samples. Pearson correlations were used to explore significant associations of productivity with baseline characteristics. A two-part model was used to evaluate both the occurrence and of size of productivity losses in working PLWH and an aggregated sample of PLWH and the general population. It was observed that, on average, total productivity losses do not differ significantly between working PWLH and the general working population, but that the occurrence and size of absenteeism and presenteeism were different. Furthermore, more health problems were associated with higher productivity losses. HIV status was not significantly associated with productivity losses. We conclude that among working people, health status was related to productivity losses but HIV status was not. However, further research is needed into the relation between HIV status and unemployment.
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Affiliation(s)
- Kaya Verbooy
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands
| | - Marlies Wagener
- b Centre of Expertise Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , the Netherlands.,c Department of Viroscience , Erasmus Medical Centre Rotterdam , Rotterdam , the Netherlands
| | - Meriam Kaddouri
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands
| | - Pepijn Roelofs
- b Centre of Expertise Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , the Netherlands
| | - Harald Miedema
- b Centre of Expertise Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , the Netherlands
| | - Eric van Gorp
- c Department of Viroscience , Erasmus Medical Centre Rotterdam , Rotterdam , the Netherlands.,d Department of Internal Medicine , Erasmus Medical Centre Rotterdam , Rotterdam , the Netherlands
| | - Werner Brouwer
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands
| | - Job van Exel
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands.,e Erasmus School of Economics , Erasmus University Rotterdam , Rotterdam , the Netherlands
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Mahlich J, Matsuoka K, Nakamura Y, Sruamsiri R. The relationship between socio-demographic factors, health status, treatment type, and employment outcome in patients with inflammatory bowel disease in Japan. BMC Public Health 2017; 17:623. [PMID: 28676039 PMCID: PMC5496236 DOI: 10.1186/s12889-017-4516-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/19/2017] [Indexed: 12/13/2022] Open
Abstract
Background Inflammatory Bowel Disease (IBD) constitutes a huge burden for patients and studies show that IBD patients have difficulties remaining in employment. Because there is no data about the unemployment of IBD patients in Japan. Methods We surveyed a representative sample of 1068 Japanese IBD patients regarding their employment status. Results We found that the labor force participation rate is lower and unemployment higher for patients with IBD compared to the general population. Factors associated with unemployment in the IBD sample are older age, female gender, and the prevalence of depression. Discussion IBD constitutes a high burden for patients in Japan regarding employment outcome.
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Affiliation(s)
- J Mahlich
- Health Economics, Janssen Pharmaceutical KK, 5-2, Nishi-kanda 3-chome Chiyoda-ku, Tokyo, 101-0065, Japan. .,Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany.
| | - K Matsuoka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Nakamura
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan
| | - R Sruamsiri
- Health Economics, Janssen Pharmaceutical KK, 5-2, Nishi-kanda 3-chome Chiyoda-ku, Tokyo, 101-0065, Japan.,Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand
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Huang YLA, Frazier EL, Sansom SL, Farnham PG, Shrestha RK, Hutchinson AB, Fagan JL, Viall AH, Skarbinski J. Nearly Half Of US Adults Living With HIV Received Federal Disability Benefits In 2009. Health Aff (Millwood) 2017; 34:1657-65. [PMID: 26438741 DOI: 10.1377/hlthaff.2015.0249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The effects of HIV infection on national labor-force participation have not been rigorously evaluated. Using data from the Medical Monitoring Project and the National Health Interview Survey, we present nationally representative estimates of the receipt of disability benefits by adults living with HIV receiving care compared with the general US adult population. We found that in 2009, adults living with HIV were nine times more likely than adults in the general population to receive disability benefits. The risk of being on disability is also greater for younger and more educated adults living with HIV compared to the general population, which suggests that productivity losses can result from HIV infection. To prevent disability, early diagnosis and treatment of HIV are essential. This study offers a baseline against which to measure the impacts of recently proposed or enacted changes to Medicaid and private insurance markets, including the Affordable Care Act and proposed revisions to the Social Security Administration's HIV Infection Listings.
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Affiliation(s)
- Ya-Lin A Huang
- Ya-Lin A. Huang is a health services researcher in the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | - Emma L Frazier
- Emma L. Frazier is an epidemiologist in the Division of HIV/AIDS Prevention, CDC
| | - Stephanie L Sansom
- Stephanie L. Sansom is a health services researcher in the Division of HIV/AIDS Prevention, CDC
| | - Paul G Farnham
- Paul G. Farnham is an economist in the Division of HIV/AIDS Prevention, CDC
| | - Ram K Shrestha
- Ram K. Shrestha is an economist in the Division of HIV/AIDS Prevention, CDC
| | - Angela B Hutchinson
- Angela B. Hutchinson is an economist in the Division of HIV/AIDS Prevention, CDC
| | - Jennifer L Fagan
- Jennifer L. Fagan is a behavioral scientist in the Division of HIV/AIDS Prevention, CDC
| | - Abigail H Viall
- Abigail H. Viall is a public health analyst in the Division of HIV/AIDS Prevention, CDC
| | - Jacek Skarbinski
- Jacek Skarbinski is a medical officer in the Division of HIV/AIDS Prevention, CDC
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11
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Annequin M, Lert F, Spire B, Dray-Spira R. Increase in Unemployment over the 2000's: Comparison between People Living with HIV and the French General Population. PLoS One 2016; 11:e0165634. [PMID: 27814374 PMCID: PMC5096670 DOI: 10.1371/journal.pone.0165634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/14/2016] [Indexed: 12/13/2022] Open
Abstract
Background Despite improved health, unemployment has increased among people living with HIV (PlwHIV) over the last decade. However, since the economic recession of 2008, unemployment also increased in the French general population. This paper aimed to determine if the increase in the unemployment rate in the HIV population was higher than that in the French general population. Methods We used data from the ANRS-Vespa study, a repeated cross-sectional survey among two national representative samples of PlwHIV followed at hospitals in France in 2003 and 2011. We compared employment and unemployment rates between HIV-infected people (overall and according to period of HIV diagnosis) and the French general population in 2003 and 2011, using multivariate Poisson regressions adjusted for individual sociodemographic characteristics. Results The employment rate among PlwHIV was consistently lower than that in the general population in 2003 and 2011. In contrast, there was a trend of an increasing unemployment rate difference between PlwHIV and the general population: PlwHIV’s unemployment rate was 1.48 (95% confidence interval [CI]: 1.16–1.90) times higher than that of the general population in 2003, versus 1.62 (95% CI: 1.34–1.96) times higher in 2011. This unemployment rate difference was the highest for PlwHIV diagnosed in or after 2008 (adjusted prevalence rate ratio: 2.06; 95% CI: 1.59–2.67). Conclusions These results suggest that in time of economic recession, an increasing proportion of PlwHIV may be excluded from the labor market although they are willing to re-enter it. This constitutes a major issue relative to social consequences of chronic disease.
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Affiliation(s)
- Margot Annequin
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F75012, Paris, France
- * E-mail:
| | - France Lert
- INSERM, U1018, Center for Research in Epidemiology and Population Health, Villejuif, France
| | - Bruno Spire
- INSERM, UMR912, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Rosemary Dray-Spira
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F75012, Paris, France
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Elzi L, Conen A, Patzen A, Fehr J, Cavassini M, Calmy A, Schmid P, Bernasconi E, Furrer H, Battegay M. Ability to Work and Employment Rates in Human Immunodeficiency Virus (HIV)-1-Infected Individuals Receiving Combination Antiretroviral Therapy: The Swiss HIV Cohort Study. Open Forum Infect Dis 2016; 3:ofw022. [PMID: 26955645 PMCID: PMC4777901 DOI: 10.1093/ofid/ofw022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/28/2016] [Indexed: 11/13/2022] Open
Abstract
Background. Limited data exist on human immunodeficiency virus (HIV)-infected individuals' ability to work after receiving combination antiretroviral therapy (cART). We aimed to investigate predictors of regaining full ability to work at 1 year after starting cART. Methods. Antiretroviral-naive HIV-infected individuals <60 years who started cART from January 1998 through December 2012 within the framework of the Swiss HIV Cohort Study were analyzed. Inability to work was defined as a medical judgment of the patient's ability to work as 0%. Results. Of 5800 subjects, 4382 (75.6%) were fully able to work, 471 (8.1%) able to work part time, and 947 (16.3%) were unable to work at baseline. Of the 947 patients unable to work, 439 (46.3%) were able to work either full time or part time at 1 year of treatment. Predictors of recovering full ability to work were non-white ethnicity (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.20-3.54), higher education (OR, 4.03; 95% CI, 2.47-7.48), and achieving HIV-ribonucleic acid <50 copies/mL (OR, 1.83; 95% CI, 1.20-2.80). Older age (OR, 0.55; 95% CI, .42-.72, per 10 years older) and psychiatric disorders (OR, 0.24; 95% CI, .13-.47) were associated with lower odds of ability to work. Recovering full ability to work at 1 year increased from 24.0% in 1998-2001 to 41.2% in 2009-2012, but the employment rates did not increase. Conclusions. Regaining full ability to work depends primarily on achieving viral suppression, absence of psychiatric comorbidity, and favorable psychosocial factors. The discrepancy between patients' ability to work and employment rates indicates barriers to reintegration of persons infected with HIV.
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Affiliation(s)
- Luigia Elzi
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research , University Hospital Basel
| | - Anna Conen
- Division of Infectious Diseases , Cantonal Hospital Aarau
| | - Annalea Patzen
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research , University Hospital Basel
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology , University Hospital Zurich
| | - Matthias Cavassini
- Infectious Diseases Service, University Hospital and University of Lausanne
| | - Alexandra Calmy
- Division of Infectious Diseases , University Hospital Geneva
| | - Patrick Schmid
- Division of Infectious Diseases , Cantonal Hospital , St. Gallen
| | - Enos Bernasconi
- Division of Infectious Diseases , Regional Hospital , Lugano
| | - Hansjakob Furrer
- Department of Infectious Diseases , University Hospital Bern and University of Bern , Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research , University Hospital Basel
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Garriga C, García de Olalla P, Miró JM, Ocaña I, Knobel H, Barberá MJ, Humet V, Domingo P, Gatell JM, Ribera E, Gurguí M, Marco A, Caylà JA. Mortality, Causes of Death and Associated Factors Relate to a Large HIV Population-Based Cohort. PLoS One 2015; 10:e0145701. [PMID: 26716982 PMCID: PMC4696823 DOI: 10.1371/journal.pone.0145701] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 12/06/2015] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Antiretroviral therapy has led to a decrease in HIV-related mortality and to the emergence of non-AIDS defining diseases as competing causes of death. This study estimates the HIV mortality rate and their risk factors with regard to different causes in a large city from January 2001 to June 2013. MATERIALS AND METHODS We followed-up 3137 newly diagnosed HIV non-AIDS cases. Causes of death were classified as HIV-related, non-HIV-related and external. We examined the effect of risk factors on survival using mortality rates, Kaplan-Meier plots and Cox models. Finally, we estimated survival for each main cause of death groups through Fine and Gray models. MORTALITY RESULTS 182 deaths were found [14.0/1000 person-years of follow-up (py); 95% confidence interval (CI):12.0-16.1/1000 py], 81.3% of them had a known cause of death. Mortality rate by HIV-related causes and non-HIV-related causes was the same (4.9/1000 py; CI:3.7-6.1/1000 py), external was lower [1.7/1000 py; (1.0-2.4/1000 py)]. SURVIVAL RESULTS Kaplan-Meier estimate showed worse survival in intravenous drug user (IDU) and heterosexuals than in men having sex with men (MSM). Factors associated with HIV-related causes of death include: IDU male (subHazard Ratio (sHR):3.2; CI:1.5-7.0) and <200 CD4 at diagnosis (sHR:2.7; CI:1.3-5.7) versus ≥500 CD4. Factors associated with non-HIV-related causes of death include: ageing (sHR:1.5; CI:1.4-1.7) and heterosexual female (sHR:2.8; CI:1.1-7.3) versus MSM. Factors associated with external causes of death were IDU male (sHR:28.7; CI:6.7-123.2) and heterosexual male (sHR:11.8; CI:2.5-56.4) versus MSM. CONCLUSION AND RECOMMENDATION There are important differences in survival among transmission groups. Improved treatment is especially necessary in IDUs and heterosexual males.
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Affiliation(s)
- César Garriga
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
- Spanish Field Epidemiology Training Programme, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- * E-mail: (CG); (PGdO)
| | - Patricia García de Olalla
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail: (CG); (PGdO)
| | - Josep M. Miró
- Hospital Clinic- August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Inma Ocaña
- Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hernando Knobel
- Internal Medicine-Infectious Diseases, Hospital del Mar, Barcelona, Spain
| | - Maria Jesús Barberá
- Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victoria Humet
- Direcció General de Serveis Penitenciaris i de Rehabilitació, Departament de Justícia, Barcelona, Spain
| | - Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep M. Gatell
- Hospital Clinic- August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Esteve Ribera
- Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mercè Gurguí
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrés Marco
- Direcció General de Serveis Penitenciaris i de Rehabilitació, Departament de Justícia, Barcelona, Spain
| | - Joan A. Caylà
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Ahlström MG, Feldt-Rasmussen B, Legarth R, Kronborg G, Pedersen C, Larsen CS, Gerstoft J, Obel N. Smoking and renal function in people living with human immunodeficiency virus: a Danish nationwide cohort study. Clin Epidemiol 2015; 7:391-9. [PMID: 26357490 PMCID: PMC4559253 DOI: 10.2147/clep.s83530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Smoking is a main risk factor for morbidity and mortality in people living with human immunodeficiency virus (PLHIV), but its potential association with renal impairment remains to be established. METHODS We did a nationwide population-based cohort study in Danish PLHIV to evaluate the association between smoking status and 1) overall renal function and risk of chronic kidney disease (CKD), 2) risk of any renal replacement therapy (aRRT), and 3) mortality following aRRT. We calculated estimated creatinine clearance using the Cockcroft-Gault equation (CG-CrCl), and evaluated renal function graphically. We calculated cumulative incidence of CKD (defined as two consecutive CG-CrCls of ≤60 mL/min, ≥3 months apart) and aRRT and used Cox regression models to calculate incidence rate ratios (IRRs) for risk of CKD, aRRT, and mortality rate ratios (MRRs) following aRRT. RESULTS From the Danish HIV Cohort Study, we identified 1,475 never smokers, 768 previous smokers, and 2,272 current smokers. During study period, we observed no association of smoking status with overall renal function. Previous and current smoking was not associated with increased risk of CKD (adjusted IRR: 1.1, 95% confidence interval [CI]: 0.7-1.7; adjusted IRR: 1.3, 95% CI: 0.9-1.8) or aRRT (adjusted IRR: 0.8, 95% CI: 0.4-1.7; adjusted IRR: 0.9, 95% CI: 0.5-1.7). Mortality following aRRT was high in PLHIV and increased in smokers vs never smokers (adjusted MRR: 3.8, 95% CI: 1.3-11.2). CONCLUSION In Danish PLHIV, we observed no strong association between smoking status and renal function, risk of CKD, or risk of aRRT, but mortality was increased in smokers following aRRT.
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Affiliation(s)
- Magnus Glindvad Ahlström
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rebecca Legarth
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Carsten Schade Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Abstract
OBJECTIVES In a context marked by major changes in the field of HIV and in the general socioeconomic context, this study aimed at investigating changes in the employment situation of people living with HIV (PLWHIV) in France since the early 2000s. DESIGN Repeated cross-sectional survey among two nationally representative samples of PLWHIV followed at hospital in France in 2003 (N = 2932) and 2011 (N = 3022). METHODS Differences between 2003 and 2011 in (1) rates of employment, unemployment, and inactivity and (2) rates of work cessation and access to work following HIV diagnosis were measured using two-step multivariate Poisson regression models adjusted for individual sociodemographic determinants of position on the labor market, and then additionally for health status characteristics. RESULTS Overall, among working-age PLWHIV 60.9% in 2003 and 59.6% in 2011 were employed; 12.6 and 15.8%, respectively, were unemployed; and 26.5 and 24.6%, respectively, were inactive. Adjusting for sociodemographic determinants of position on the labor market, while employment rate was not different in 2011 compared with 2003, inactivity rate significantly decreased (adjusted prevalence rate ratio: 0.83, 95% confidence interval: [0.72-0.96]) and unemployment rate significantly increased (1.28 [1.04-1.57]). After additional adjustment for health status characteristics, the difference was no longer significant for inactivity (0.89 [0.77-1.03]) but remained significant for unemployment (1.55 [1.24-1.93]). Compared with 2003, in 2011 transitions to unemployment following HIV diagnosis tended to be more frequent (1.58 [0.92-2.68]) and access to work was significantly less frequent (0.57 [0.33-0.99]). CONCLUSION Improvements in HIV care have not translated into improvements in PLWHIV's situation regarding employment.
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Cost-effectiveness of population-level expansion of highly active antiretroviral treatment for HIV in British Columbia, Canada: a modelling study. Lancet HIV 2015; 2:e393-400. [PMID: 26423553 DOI: 10.1016/s2352-3018(15)00127-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Widespread HIV screening and access to highly active antiretroviral treatment (ART) were cost effective in mathematical models, but population-level implementation has led to questions about cost, value, and feasibility. In 1996, British Columbia, Canada, introduced universal coverage of drug and other health-care costs for people with HIV/AIDS and and began extensive scale-up in access to ART. We aimed to assess the cost-effectiveness of ART scale-up in British Columbia compared with hypothetical scenarios of constrained treatment access. METHODS Using comprehensive linked population-level data, we populated a dynamic, compartmental transmission model to simulate the HIV/AIDS epidemic in British Columbia from 1997 to 2010. We estimated HIV incidence, prevalence, mortality, costs (in 2010 CAN$), and quality-adjusted life-years (QALYs) for the study period, which was 1997-2010. We calculated incremental cost-effectiveness ratios from societal and third-party-payer perspectives to compare actual practice (true numbers of individuals accessing ART) to scenarios of constrained expansion (75% and 50% probability of accessing ART). We also investigated structural and parameter uncertainty. FINDINGS Actual practice resulted in 263 averted incident cases compared with 75% of observed access and 676 averted cases compared with 50% of observed access to ART. From a third-party-payer perspective, actual practice resulted in incremental cost-effectiveness ratios of $23 679 per QALY versus 75% access and $24 250 per QALY versus 50% access. From a societal perspective, actual practice was cost saving within the study period. When the model was extended to 2035, current observed access resulted in cumulative savings of $25·1 million compared with the 75% access scenario and $65·5 million compared with the 50% access scenario. INTERPRETATION ART scale-up in British Columbia has decreased HIV-related morbidity, mortality, and transmission. Resulting incremental cost-effectiveness ratios for actual practice, derived within a limited timeframe, were within established cost-effectiveness thresholds and were cost saving from a societal perspective. FUNDING BC Ministry of Health, National Institute of Drug Abuse at the US National Institutes of Health.
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Legarth R, Omland LH, Dalton SO, Kronborg G, Larsen CS, Pedersen C, Pedersen G, Gerstoft J, Obel N. Association Between Educational Level and Risk of Cancer in HIV-infected Individuals and the Background Population: Population-based Cohort Study 1995-2011. J Infect Dis 2015; 212:1552-62. [PMID: 25904603 DOI: 10.1093/infdis/jiv247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/16/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected individuals have increased risk of cancer. To our knowledge, no previous study has examined the impact of socioeconomic position on risk and prognosis of cancer in HIV infection. METHODS Population-based cohort-study, including HIV-infected individuals diagnosed (without intravenous drug abuse or hepatitis C infection) (n = 3205), and a background population cohort matched by age, gender, and country of birth (n = 22 435) were analyzed. Educational level (low or high) and cancer events were identified in Danish national registers. Cumulative incidences, incidence rate ratios (IRRs), and survival using Kaplan-Meier methods were estimated. RESULTS Low educational level was associated with increased risk of cancer among HIV-infected individuals compared to population controls: all (adjusted-IRRs: 1.4 [95% confidence interval {CI}, 1.1-1.7] vs 1.1 [95% CI, .9-1.2]), tobacco- and alcohol-related (2.1 [95% CI, 1.3-3.4] vs 1.3 [95% CI, 1.1-1.6]), and other (1.7 [95% CI, 1.1-2.8] vs 0.9 [95% CI, .7-1.0]). Educational level was not associated with infection-related or ill-defined cancers. One-year-survival was not associated with educational level, but HIV-infected individuals with low educational level had lower 5-year-survival following infection-related and ill-defined cancers. CONCLUSIONS Education is associated with risk and prognosis of some cancers in HIV infection, and diverges from what is observed in the background population.
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Affiliation(s)
- Rebecca Legarth
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | | | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital
| | | | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
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Omland LH, Ahlström MG, Obel N. Cohort profile update: the Danish HIV Cohort Study (DHCS). Int J Epidemiol 2014; 43:1769-9e. [PMID: 25074406 DOI: 10.1093/ije/dyu153] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The DHCS is a cohort of all HIV-infected individuals seen in one of the eight Danish HIV centres after 31 December 1994. Here we update the 2009 cohort profile emphasizing the development of the cohort. Every 12-24 months, DHCS is linked with the Danish Civil Registration System (CRS) in order to extract an age- and sex-matched comparison cohort from the general population, as well as cohorts of family members of the HIV-infected patients and of the comparison cohort. The combined cohort is linked with CRS, the Danish Cancer Registry, the Danish National Hospital Registry, the Danish Registry of Causes of Death, the Danish National Prescription Registry, the Attainment Register and the Integrated Database for Labour Market Research to get information on vital status, migration, cancer, hospital contacts, causes of death, dispensed prescriptions, education and employment. Using this design, rates of a range of outcomes have been compared between HIV-infected patients and the comparison cohort, as well as between families of these two cohorts in order to disaggregate the effects of HIV infection and familial/environmental factors. Data can be shared with foreign institutions following approval from the Danish Data Protection Agency. Potential collaborators can contact the study director, Niels Obel (e-mail: niels.obel@regionh.dk).
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Affiliation(s)
- Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Magnus Glindvad Ahlström
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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