Mortality rates by race/ethnicity, gender, and HIV risk group among - - PowerPoint PPT Presentation

Mortality rates by race/ethnicity, gender, and HIV risk group among HIV-infected individuals with equal access to health care

Wendy Leyden1, Sally Slome2, Michael Allerton3, Michael A. Horberg4, Leo B. Hurley1, Daniel B. Klein5, Michael J. Silverberg1

Kaiser Permanente Northern California, 1Division of Research, Oakland, CA; 2Oakland Medical Center, Oakland, CA; 5 Hayward Medical Center, Hayward, CA; 3 The Permanente Medical Group, Oakland, CA;

4Mid-Atlantic Permanente Research Institute, Rockville, MD

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Study methods and patient population

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Study population: n=10,158 HIV(+) adult members from Kaiser Permanente California, 1996-2009. Study outcomes and predictors: Death during study period. Race/ethnicity, HIV risk group, age, calendar year. Analysis: Compared mortality rate and rate ratios by race/ethnicity and HIV risk group. Adjusted rate ratios (RR) for all- cause mortality; adjusted for age, sex, race/ethnicity, and calendar year.

All Whites Blacks Hispanics Asians p-value 6,307 1,842 1,507 502 (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 N (% of total sample) 10,158 (100%)

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Mortality rates and rate ratios by race/ethnicity and HIV risk group

All Years 1996-99 2000-04 2005-09 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)

• verall 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)

• verall p-value

<0.001 0.002 0.017 0.189

1 Models adjusted for age, race/ethnicity, HIV risk group, and calendar year

Adjusted1 Rate Ratio (95% CI) # deaths Crude Rate/ 100 pyrs

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Crude mortality rates over time

By race/ethnicity By HIV risk group

Asians = green line Whites = black line Blacks = red line Hispanics = blue line All declines <0.001 Men, hetero = red line Men, IDU = blue line MSM = green line Women = black line All declines <0.001

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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