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Ashraf H, Nadeem A, Ashfaq H, Fatima T, Ahmed S, Nadeem ZA, Saleh A. Disparities in mortality trends of adults with HIV in the USA: A comprehensive examination across 2 decades. Medicine (Baltimore) 2024; 103:e38570. [PMID: 38905388 PMCID: PMC11191943 DOI: 10.1097/md.0000000000038570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/23/2024] [Indexed: 06/23/2024] Open
Abstract
Approximately 38 million people worldwide are affected by human immunodeficiency virus (HIV), with 4000 new infections daily. While literature explores HIV mortality among the elderly in the US, there is an underrepresentation of mortality data for adults. By scrutinizing mortality trends based on demographic factors such as gender, race or ethnicity, age groups, and geographic location, the study seeks to uncover patterns that may facilitate a longitudinal perspective for tailoring interventions and allocating resources effectively. Crude death rates and age-adjusted mortality rates (AAMR) per 100,000 individuals were calculated using HIV mortality data (ICD-10 Codes B20-24) from CDC WONDER database. Permutation test was used to calculate annual percentage changes in AAMR with 95% confidence interval. Average annual percentage changes were computed as weighted average of annual percentage changes. Between 1999 to 2020, US adult HIV deaths totaled 225,396 (AAMR: 5.03), with a significantly decreasing average annual percentage changes (-5.94). Males exhibited a 3-fold higher AAMR (7.50) than females (2.67). Non-Hispanic Blacks had the highest AAMR (21.82), while Non-Hispanic Asians had the lowest (0.67). The South and Northeast regions had the highest AAMRs (6.91 and 6.33, respectively). Notably, the District of Columbia had an alarmingly high mortality rate of 39.9, while North Dakota had the lowest (0.7). Urban regions (5.47) had double the mortality rates of rural regions (2.70). Mortality rate peaked in age groups 45 to 54 (8.65) and 35 to 44 (7.42). While overall HIV mortality is declining, disparities persist among demographics. Targeted interventions are crucial to improve preventive measures and healthcare access for disproportionately affected groups.
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Affiliation(s)
- Hamza Ashraf
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Aimen Nadeem
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Haider Ashfaq
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Tehniat Fatima
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Sophia Ahmed
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Zain Ali Nadeem
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Aalaa Saleh
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Chan SY, Lai YJ, Ko MC, Chen YY, Tsai YF, Hsu LF, Ku PW, Chen LJ, Chuang PH, Chen CC, Yen YF. Is there lower utilisation of hospice care services during end-of-life care for people living with HIV? A population-based cohort study. BMJ Open 2022; 12:e058231. [PMID: 35288396 PMCID: PMC8921921 DOI: 10.1136/bmjopen-2021-058231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Hospice care could improve the quality of life among advanced HIV patients during end-of-life (EOL) treatment. However, providing hospice care services for people living with HIV (PLWH) is challenging due to HIV-related stigma. This nationwide cohort study aims to determine the utilisation of hospice care services among PLWH and HIV-negative individuals during EOL treatment. DESIGN A retrospective cohort study. SETTING From 2000 to 2018, we identified adult PLWH from the Taiwan centres for disease control HIV Surveillance System. Individuals who had positive HIV-1 western blots were regarded as HIV-infected. Age-matched and sex-matched controls without HIV infection were selected from the Taiwan National Health Insurance Research Database for comparison. All PLWH and controls were followed until death or 31 December 2018. PARTICIPANTS 32 647 PLWH and 326 470 HIV-negative controls were analysed. PRIMARY OUTCOME MEASURES Utilisation of hospice care services during the last year of life among PLWH and HIV-negative individuals. RESULTS A total of 20 413 subjects died during the 3 434 699 person-years of follow-up. Of the deceased patients, 2139 (10.5%) utilised hospice care services during their last year of life, including 328 (5.76%) PLWH and 1811 (12.30%) controls. Adjusting for demographics and comorbidities, PLWH were less likely to receive hospice care services during the last year of life, compared with HIV-negative individuals (adjusted OR: 0.66; 95% CI: 0.57 to 0.75). CONCLUSIONS PLWH had significantly lower utilisation of hospice care services during the last year of life. Our results suggest that future hospice care programmes should particularly target PLWH to increase the optimal utilisation of hospice care services during EOL treatment.
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Affiliation(s)
- Shang-Yih Chan
- Department of Internal Medicine, Taipei City Hospital Yangming Branch, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
| | - Yun-Ju Lai
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Ming-Chung Ko
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Urology, Taipei City Hospital, Taipei, Taiwan
| | - Yu-Yen Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Fan Tsai
- Department of Nursing, Yangming Branch, Taipei, Taiwan
- School of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Li-Fei Hsu
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Po-Wen Ku
- Graduate Institute of Sports and Health, National Chung Hsing University, Taichung, Taiwan
| | - Li-Jung Chen
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Pei-Hung Chuang
- Taipei Association of Health and Welfare Data Science, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yung-Feng Yen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
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Cianelli R, Villegas N, Lewis-Pierre L, Valdes B, Iriarte E. Predictors of End of Life Discussions Among Minority Older Women Living With HIV Infection. Am J Hosp Palliat Care 2020; 38:583-589. [PMID: 33213192 DOI: 10.1177/1049909120971826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Among the 39,782 newly HIV diagnosed individuals in the U.S., 17% were aged 50+. Although premature aging, morbidity, and mortality are issues for older people living with HIV that threaten their quality of life, less attention has been focused on end of life (EOL) discussions. OBJECTIVES To examine predictors of EOL discussions with significant others, family members, and friends. METHODS Cross-sectional design was used for this study guided by the The Socio Ecological Model (SEM). Sample: 119 Black and 19 Hispanic women aged 50+ living with HIV. RESULTS Predictors of EOL discussions were education, living with a partner, religiosity, and pain, which were at the individual-intrapersonal level of the SEM. DISCUSSION Findings from this study have important implications for health policy makers and clinicians because they cast a bright light on the substantial continued effort that is needed to improve EOL discussions. .
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Affiliation(s)
- Rosina Cianelli
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.,Pontificia Universidad Catolica de Chile Escuela de Enfermeria, Santiago, Chile
| | - Natalia Villegas
- 16134University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
| | - LaToya Lewis-Pierre
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Beatriz Valdes
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Evelyn Iriarte
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.,Pontificia Universidad Catolica de Chile Escuela de Enfermeria, Santiago, Chile
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