This award-winning blog supplements the articles in Hospital Infection Control & Prevention.
HIV by state: Where you live, where you die
January 12th, 2015
HIV/AIDS mortality data highlight disparities between states, suggesting differences in HIV treatment and care, a new study shows.1 Investigators compared HIV/AIDS data from 37 states that have collected confidential HIV reporting data for most of the past decade. They found geographic disparities in HIV mortality. “We combined data from two national sources,” says David Hanna, MS, a doctoral student in epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore, MD. “The first source was the national HIV/AIDS reporting system maintained by the Centers for Disease Control and Prevention,” he says. “The other data source is the national vital statistics system maintained by the National Center for Health Statistics, which contains data for all reported deaths in the country.” With data from 2001 to 2007, researchers calculated mortality rates due to HIV and AIDS, finding out what the HIV death rate was in the state’s general population, calculated as HIV death rate per 100,000 population person-years. Then they looked more specifically at the mortality rate among only HIV-positive populations, describing this as the HIV case-fatality rate per 1,000 HIV-infected person years. “We collaborated with the CDC to generate this information,” Hanna says. When investigators charted the conventional HIV death rate and compared it with the HIV case-fatality rate among HIV-infected populations, they found that the Southeast was dominant in both measures. States like Mississippi, North Carolina, Tennessee, Louisiana, Georgia, South Carolina, and Florida were ranked in the top 10 on both lists. For instance, Florida has the highest HIV death rate with 12.5 HIV deaths per 100,000 population, and it has the 10th highest HIV case-fatality rate with 24.2 HIV deaths per 1,000 HIV-infected person years.1 Louisiana ranks second in both measures with 11.2 HIV deaths per 100,000 person-years and 32.5 HIV deaths per 1,000 HIV-infected person years.1 New York and New Jersey rank third and fifth in the conventional HIV death rate, but their rankings fall to 30th and 15th when it comes to HIV deaths per 1,000 HIV-infected person years.1 “We know that New York has a relatively high number of residents infected with HIV, and consequently a high number of deaths due to the sheer size of its HIV population,” Hanna explains. “However, when we calculated the HIV case-fatality rate to take into account the number of deaths occurring among HIV-infected people only, we found that at 14.7 per 1,000, New York’s rate is quite low,” he adds. “This suggests that the risk of death for those with HIV is lower in New York state than in many other states.” It might also suggest that New York does a good job at identifying new HIV infections and getting people into care, although the epidemiological findings can only suggest this as a possibility. “Then, let’s look at South Carolina, which has a conventional death rate ranking of sixth out of 37 states -- with 8.6 deaths per 100,000 person years,” Hanna says. “Similarly, the state’s case-fatality rate ranks at seventh out of 37 states, with 25.2 deaths per 1,000 person-years” he says. “So with respect to South Carolina, HIV mortality appears relatively high regardless of the metric used.” As national public health policymakers address the HIV epidemic and disparities, they should keep in mind geographic disparities, Hanna suggests. “Ultimately, we’re trying to identify factors that policymakers can understand to help them formulate strategies to improve the health of people with HIV,” he adds. “Race and transmission risk are important, but we want to show there are other factors that should be taken into consideration, like geography,” Hanna says. “States provide different environments with respect to health insurance, prescription drug coverage, and other economic factors, and these cannot be ignored.” --Melinda Young
1. Hanna DB, Selik RM, Tang T, et al. Disparities among states in HIV-related mortality in persons with HIV infection, 37 U.S. states, 2001-2007. AIDS. 2011;[Epub ahead of print.]