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

Autor: Krueger AL; 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. frf7@cdc.gov.; School of Health Sciences, University of Tampere, 33014, Tampere, Finland. frf7@cdc.gov., Van Handel M; 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., Dietz PM; 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., Williams WO; 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.; Public Health Analytic Consulting Services, Inc., 917 Craftsman Street, Hillsborough, NC, 27278, USA., Satcher Johnson A; 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., Klein PW; HIV/AIDS Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20857, USA., Cohen S; HIV/AIDS Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20857, USA., Mandsager P; HIV/AIDS Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20857, USA., Cheever LW; HIV/AIDS Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20857, USA., Rhodes P; 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., Purcell DW; 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.
Jazyk: angličtina
Zdroj: Journal of community health [J Community Health] 2019 Oct; Vol. 44 (5), pp. 963-973.
DOI: 10.1007/s10900-019-00655-4
Abstrakt: 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.
Databáze: MEDLINE
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