Examining Disparities in HIV Mortality That Remain Underexamined

Despite advances in HIV management, mortality trends in the U.S. population remain insufficiently studied, hindering evidence-based interventions. This analysis examines HIV-related mortality across demographic factors—age, gender, race/ethnicity, urbanization, and U.S. Census Regions—using state and county-level Age-Adjusted Mortality Rates (AAMR).

At IDWeek, Muhammad Sohaib Asghar (Sohaib), MBBS, MD, resident physician at AdventHealth Sebring discussed key factors identified that contributed to the trends in HIV mortality, and how might these insights guide future public health strategies, “There are many known risk factors for HIV mortality, such as male gender and African American race, but a significant recent factor is socio-economic determinants. States like Florida, Georgia, and Louisiana have higher prevalence rates, which directly correlate with increased mortality. Understanding these factors is crucial for guiding future public health strategies.”

From 1999 to 2023, there were 271,568 HIV-related deaths (AAMR=3.4 per 100,000; 95% CI: 3.3-3.5). Overall mortality decreased at an annual rate of -4.66% (95% CI: -4.96, -4.43). However, trends showed increases among males (2018-2021), individuals aged 65-84, Non-Hispanic American Indian or Alaskan Natives (2017-2023), and in all regions (2018-2021). Top affected states included the District of Columbia, Florida, Maryland, Louisiana, New York, and Georgia. Notably, Union and Miami-Dade Counties in Florida reported high rates, while Mississippi exhibited the slowest decline.

Asghar discussed the strengths and limitations of using the CDC WONDER Database for this study and how they influenced findings. “CDC Wonder is a very large database, very comprehensive. We have many socio-demographic variables that we can use to stratify the data… The only drawback that I found from the CDC Wonder database is that it is based on the Billing Coding System, so lots of times we don’t have specific underlying cause of death.”

Data were sourced from the CDC WONDER Database, utilizing ICD-10 codes (B20-B24) to identify HIV-related deaths from 1999 to 2023. Trends were evaluated via Joinpoint regression for annual percent changes (APC), with urbanization classified per the NCHS 2013 scheme.

Asghar discussed recommendations for policymakers and clinicians to enhance HIV prevention and treatment efforts in the US, “Targeted intervention should be at primary care level. Primary care providers should be able to take care of these patients, provide the supply kits, not all of the patients are able to take care of them or be preventive about them. Going back to restrategize at community-based levels would surely make sure that we end this endemic throughout the country.”

While overall HIV mortality decreased from 1999 to 2023, disparities exist across demographics and regions. Enhanced public health surveillance is necessary to identify high-risk groups for targeted interventions.

Reference

HIV Mortality Trends among the United States Population from 1999-2023: A Retrospective Study using the CDC Wonder Database. Poster 390 presented at IDWeek 2024. October 16-19, 2024. Los Angeles, CA.