Impact of subgroup-specific heterogeneities and dynamic changes in mortality rates on forecasted population size, deaths, and age distribution of persons receiving antiretroviral treatment in the United States: a computer simulation study.

Autor: Kasaie P; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: pkasaie@jhu.edu., Stewart C; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Humes E; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Gerace L; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Hyle EP; Medical Practice Evaluation Center, Massachusetts General Hospital; Division of Infectious Diseases, Massachusetts General Hospital, Boston; Harvard Medical School, Boston., Zalla LC; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Rebeiro PF; Department of Medicine & Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN., Silverberg MJ; Division of Research, Kaiser Permanente Northern California, Oakland., Rubtsova AA; Emory University Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Atlanta, GA., Rich AJ; Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill., Gebo K; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD., Lesko CR; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Fojo AT; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD., Lang R; Department of Medicine, University of Calgary, Calgary, Alberta, Canada., Edwards JK; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill., Althoff KN; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Jazyk: angličtina
Zdroj: Annals of epidemiology [Ann Epidemiol] 2023 Nov; Vol. 87. Date of Electronic Publication: 2023 Sep 22.
DOI: 10.1016/j.annepidem.2023.09.005
Abstrakt: Purpose: Model-based forecasts of population size, deaths, and age distribution of people with HIV (PWH) are helpful for public health and clinical services planning but are influenced by subgroup-specific heterogeneities and changes in mortality rates.
Methods: Using an agent-based simulation of PWH in the United States, we examined the impact of distinct approaches to parametrizing mortality rates on forecasted epidemiology of PWH on antiretroviral treatment (ART). We first estimated mortality rates among (1) all PWH, (2) sex-specific, (3) sex-and-race/ethnicity-specific, and (4) sex-race/ethnicity-and-HIV-acquisition-risk-specific subgroups. We then assessed each scenario by (1) allowing unrestricted reductions in age-specific mortality rates over time and (2) restricting the mortality rates among PWH to subgroup-specific mortality thresholds from the general population.
Results: Among the eight scenarios examined, those lacking subgroup-specific heterogeneities and those allowing unrestricted reductions in future mortality rates forecasted the lowest number of deaths among all PWH and 9 of the 15 subgroups through 2030. The forecasted overall number and age distribution of people with a history of injection drug use were sensitive to inclusion of subgroup-specific mortality rates.
Conclusions: Our results underscore the potential risk of underestimating future deaths by models lacking subgroup-specific heterogeneities in mortality rates, and those allowing unrestricted reductions in future mortality rates.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Parastu Kasaie reports financial support was provided by National Institutes of Health. Keri Althof reports financial support was provided by National Institutes of Health. Emily Hyle reports financial support was provided by National Institutes of Health. Lauren Zalla reports financial support was provided by National Institutes of Health. Anthony Fojo reports financial support was provided by National Institutes of Health. Emily Hyle reports financial support was provided by Massachusetts General Hospital. Keri Althoff reports a relationship with TrioHealth that includes: board membership. KNA reports serving on the Scientific Advisory Board for TrioHealth Inc. and as a consultant to the All of Us Study (National Institutes of Health). PFR reports serving as a consultant for Gilead and Janssen Pharmaceuticals. Kelly Gebo is a consultant for Teach for America and the Aspen Institute and was an unpaid representative to a scientific Advisory Board for Pfizer. LCZ reports serving as a consultant for Carelon. None of these have direct relation to, or impact on, the findings presented here. All other authors declare no conflicts of interest.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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