Mortality rates by race/ethnicity, gender, and HIV risk group among HIV-infected individuals with equal access to health care Wendy Leyden 1 , Sally Slome 2 , Michael Allerton 3 , Michael A. Horberg 4 , Leo B. Hurley 1 , Daniel B. Klein 5 , Michael J. Silverberg 1 Kaiser Permanente Northern California, 1 Division of Research, Oakland, CA; 2 Oakland Medical Center, Oakland, CA; 5 Hayward Medical Center, Hayward, CA; 3 The Permanente Medical Group, Oakland, CA; 4 Mid-Atlantic Permanente Research Institute, Rockville, MD 1
Study methods and patient population Study population: n=10,158 Analysis: Compared mortality rate HIV(+) adult members from and rate ratios by race/ethnicity Kaiser Permanente California, and HIV risk group. 1996-2009. Adjusted rate ratios (RR) for all- Study outcomes and predictors: cause mortality; adjusted for age, Death during study period. sex, race/ethnicity, and calendar Race/ethnicity, HIV risk group, year. age, calendar year. All Whites Blacks Hispanics Asians p-value N 10,158 6,307 1,842 1,507 502 (% of total sample) (100%) (62.1) (18.1) (14.8) (4.9) Male (%) 90.3 94.1 76.7 91.9 89.2 <0.001 HIV risk group (%): <0.001 MSM 74.4 80.7 52.3 74.6 74.9 Het/Other men 8.3 5 16.7 11.6 10.4 IDU men 7.6 8.4 7.7 5.8 4 Women 9.7 6 23.3 8.1 10.8 Age at baseline, mean yrs 40.3 41.6 39.3 37.5 37.4 <0.001 Years followed, mean yrs 5.1 5.4 4.7 4.5 4.5 <0.001 2
Mortality rates and rate ratios by race/ethnicity and HIV risk group Adjusted 1 Rate Ratio (95% CI) # Crude Rate/ All Years 1996-99 2000-04 2005-09 deaths 100 pyrs Whites 753 2.2 (ref) (ref) (ref) (ref) Blacks 196 2.3 1.0 (0.9, 1.2) 1.0 (0.7, 1.2) 1.1 (0.8, 1.5 ) 1.1 (0.8, 1.6) Hispanics 114 1.7 0.9 (0.8, 1.1) 1.0 (0.7, 1.3) 0.9 (0.7, 1.4) 0.8 (0.6, 1.2) Asians 46 2.1 1.2 (0.9, 1.6) 1.5 (1.0, 2.3) 1.3 (0.7, 2.2) 0.7 (0.4, 1.5) overall p-value 0.480 0.355 0.765 0.412 MSM 803 2.1 (ref) (ref) (ref) (ref) Het/other men 125 3.1 1.5 (1.2, 1.8) 1.8 (1.3, 2.4) 1.3 (0.9, 1.9) 1.3 (0.9, 1.9) IDU men 95 2.9 1.5 (1.2, 1.8) 1.3 (1.0, 1.8) 1.7 (1.2, 2.5) 1.4 (0.9, 2.2) Women 86 1.7 0.9 (0.7, 1.1) 1.0 (0.7, 1.3) 0.8 (0.5, 1.3) 0.9 (0.5, 1.4) overall p-value <0.001 0.002 0.017 0.189 1 Models adjusted for age, race/ethnicity, HIV risk group, and calendar year 3
Crude mortality rates over time By race/ethnicity By HIV risk group Asians = green line Men, hetero = red line Whites = black line Men, IDU = blue line Blacks = red line MSM = green line Hispanics = blue line Women = black line All declines <0.001 All declines <0.001 4
Summary / Conclusions • In the setting of equal access to care, we did not observe a disparity in mortality by race/ethnicity • Mortality rates declined over time for all patients, but rate ratios by race did not change over time • We did find a higher risk of death among men with IDU and heterosexual/other HIV risk compared with MSM and women • Increased rate ratios among IDU and heterosexual/other men compared with MSM men declined over time and were no longer statistically significant in the most recent calendar period 5
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