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

AbstractIn 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, percent age 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 gr oups [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 gro ups (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 olde...
Source: Journal of Community Health - Category: International Medicine & Public Health Source Type: research