Premature Mortality Highest Among Black Women With HIV

Many people with HIV are living longer lives, but not all of them. In fact, data released at the 2021 virtual IDWeek conference showed that Black women continue to have the highest rate of premature death among anyone living with HIV.

In this exclusive MedPage Today video, study author Jessica Castilho, MD, MPH, of Vanderbilt University Medical Center in Nashville, discusses the study, its limitations, and future steps in working toward an explanation.

Following is a transcript of her remarks:

The reason why we did the study is that we know that HIV care and HIV outcomes have dramatically improved for the better over the past 20 years. But we know that there are still disparities across the continuum of care for people living with HIV. There are disparities in time to diagnosis, retention to care, and ultimately, HIV viral suppression and mortality.

So what our study sought to do was to examine the population of adults living with HIV, who connected to care at our HIV clinic here at Vanderbilt, and where we have longitudinal data on a large and diverse cohort of individuals from 1998 to the present on their clinical outcomes. We thought this was important because our patient population here at Vanderbilt is a representative cohort for people living with HIV in the Southeastern U.S., which is the region that's currently with the highest incidence of HIV.

We wanted to look at differences in mortality rates over time, but we also wanted to look at the topic of premature mortality, as there's been a growing interest to look at this measure as a way to quantify the impact of early deaths, or death at a younger age. And it hasn't been something that we've done widely in HIV research. So, in this study, we wanted to look at differences by race and sex, not only in mortality, but also premature mortality among individuals who had established care at our clinic.

Our study population was large and it was diverse. We included more than 6,500 individuals who had successfully linked to care in our clinic between 1998 and 2018. And we used deaths that were captured either using national death registries, or deaths that were reported to our clinic by family and friends from patients who had died. Overall about half of our population were non-Hispanic white race, and 78% were cisgender men. And overall 956 individuals died during the study period.

So there are some limitations to our study. The largest limitation is that this is a single clinic site at a single center. So our results may not be generalizable to other clinic sites or other regions across the U.S. Additionally, with being a single clinic site, we were limited with the number of individuals that we had and the number of deaths. So we couldn't look at trends in premature mortality over time. We could only look at it as a composite outcome.

And also since we're just relying on data that's abstracted from medical records, we're limited based on what's recorded as that data source. And so we didn't have a lot of the other social exposures or behavioral differences that may be in part driving some of the disparities that we saw.

I think that the biggest question with seeing this disparity, is one to certainly look at other settings and other data sources to see, is this a trend that is seen in other populations as well? How does this compare to other regions or other clinical settings? Our study shows the disparities, but we don't have a lot of information as to why those disparities are there. And so a greater attention to try to understand what were the causes of those disparities.

And some of that comes back to the limitations where we didn't have great data on cause of death, which is data that already is kind of fraught with some inherent limitations. So a deeper dive into understanding more about the individual cases and the unique and also systemic contributors to the disparity we saw are really needed.

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