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Factors Associated with State Variation in Mortality Among Persons Living with Diagnosed HIV Infection. | LitMetric

Factors Associated with State Variation in Mortality Among Persons Living with Diagnosed HIV Infection.

J Community Health

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, 1600 Clifton Road NE, Mailstop US8-2, Atlanta, GA, 30329, USA.

Published: October 2019

AI Article Synopsis

  • In the U.S., individuals living with diagnosed HIV have nearly double the mortality rate compared to the general population, prompting a study to identify modifiable factors that could help reduce this mortality.
  • The research used statistical models to analyze data from 2010-2014, focusing on factors like viral suppression in HIV programs, healthcare coverage, and state-level anti-discrimination laws.
  • Findings revealed that states with higher rates of viral suppression and healthcare coverage, as well as more comprehensive anti-discrimination laws, saw lower mortality rates among people living with HIV across different age groups, indicating potential areas for public health intervention.

Article Abstract

In the United States, the all-cause mortality rate among persons living with diagnosed HIV infection (PLWH) is almost twice as high as among the general population. We aimed to identify amendable factors that state public health programs can influence to reduce mortality among PLWH. Using generalized estimating equations (GEE), we estimated age-group-specific models (24-34, 35-54, ≥ 55 years) to assess the association between state-level mortality rates among PLWH during 2010-2014 (National HIV Surveillance System) and amendable factors (percentage of Ryan White HIV/AIDS Program (RWHAP) clients with viral suppression, percentage of residents with healthcare coverage, state-enacted anti-discrimination laws index) while controlling for sociodemographic nonamendable factors. Controlling for nonamendable factors, states with 5% higher viral suppression among RWHAP clients had a 3-5% lower mortality rates across all age groups [adjusted Risk Ratio (aRR): 0.95, 95% Confidence Interval (CI): 0.92-0.99 for 24-34 years, aRR: 0.97, 95%CI: 0.94-0.99 for 35-54 years, aRR: 0.96, 95%CI: 0.94-0.99 for ≥ 55 years]; states with 5% higher health care coverage had 4-11% lower mortality rate among older age groups (aRR: 0.96, 95%CI: 0.93-0.99 for 34-54 years; aRR: 0.89, 95%CI: 0.81-0.97 for ≥ 55 years); and having laws that address one additional area of anti-discrimination was associated with a 2-3% lower mortality rate among older age groups (aRR: 0.98, 95%CI: 0.95-1.00 for 34-54 years; aRR: 0.97, 95%CI: 0.94-0.99 for ≥ 55 years). The mortality rate among PLWH was lower in states with higher levels of residents with healthcare coverage, anti-discrimination laws, and viral suppression among RWHAP clients. States can influence these factors through programs and policies.

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Source
http://dx.doi.org/10.1007/s10900-019-00655-4DOI Listing

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