HIV death rates among uneducated black men high
■ Doctors should follow the CDC’s testing guidelines and ensure that high-risk patients maintain their treatment, a study says.
The nation’s rate of deaths due to HIV decreased significantly between 1993 and 2007, largely because of advancements in antiretroviral therapy. Yet HIV mortality rates remain high for blacks, particularly those with no more than a high school degree, according to a study published online Oct. 8 in Archives of Internal Medicine.
“There still are some groups with a really high burden of HIV deaths and for whom we need to facilitate wider access to HIV therapies,” said lead study author Edgar P. Simard, PhD, MPH, a senior epidemiologist at the American Cancer Society in Atlanta.
Physician awareness of patients who are at increased risk of developing and dying of HIV could help improve health outcomes for such individuals, the study said.
Simard recommends primary care physicians follow Centers for Disease Control and Prevention guidelines and test all patients 13 to 64 for HIV. He also encourages physicians to focus on linking patients who screen positive for HIV, particularly those at increased-risk of dying of the disease, into appropriate care. Doctors should follow up to ensure patients are continuing treatment, he said.
Likely contributing to the high HIV death rate among blacks is the greater prevalence of HIV in that population compared with other racial and ethnic groups, the study said. Other factors could include delays in HIV diagnosis among blacks, lack of receipt of antiretroviral therapy, poor medication adherence, limited access to health care and prevalence of comorbid conditions, such as tuberculosis.
Among black men with a college degree or higher, HIV deaths decreased between 1993 and 2007 from 117.89 per 100,000 population to 15.35 per 100,000. For similarly educated Hispanic men, the rate dropped from 49.84 deaths to 3.13 per 100,000 during the same period. Among white men, the rate declined from 26.42 deaths to 1.79, the study shows (link).
“Of most importance [is that] among African-Americans in the least-educated group, mortality remained the highest,” William Cunningham, MD, MPH, wrote in a commentary published in the Archives issue (link). He is a professor in the Division of General Internal Medicine at the University of California, Los Angeles, Fielding School of Public Health.
The mortality rate in 2005-07 was 52.71 deaths per 100,000 black men with no more than a high school degree compared with 9.01 per 100,000 Hispanic men and 5.04 per 100,000 white men.
Among similarly educated black women, the death rate remained largely unchanged. It was 29.89 deaths per 100,000 in 1993-95 and 26.76 in 2005-07.
“I still get goose bumps thinking about that finding. It’s very chilling” that no improvement was seen in black women with less education, Simard said. “It’s really important to get that finding out there and disseminate that there is this group of people who hasn’t benefited from [advancements in HIV medicine and care] the same as many other groups.”
The HIV mortality rate for Hispanic and white women of all education levels was low, the study said.
Resources to improve care
For the study, researchers examined data on HIV-related deaths that occurred among 91,307 adults ages 25 to 64 in 26 states between 1993 and 2007. The data were part of the National Vital Statistics System.
In the 26 states studied, there were 18,450 HIV deaths of white men in 1993-95. That number declined to 2,691 in 2005-07. During the same time period, HIV deaths of black men decreased from 11,329 to 4,362.
Researchers assessed trends in HIV-related deaths by gender, ethnicity/race and education. Education level, which was recorded on death certificates, was used as a marker for a person’s socioeconomic status. Education is associated with an individual’s health, wealth and access to health care, the study said. Low socioeconomic status has been associated with elevated HIV mortality.
During the study period, the gap widened between HIV death rates of the most- and least-educated people of the same race.
The report’s findings “suggest the need for focused interventions and resources to facilitate the identification of high-risk individuals, as well as entry and retention into care for these most vulnerable groups affected by the HIV epidemic in the United States,” the study said.
AIDSVu is a relatively new tool that could help primary care physicians identify and care for high-risk patients, said Patrick Sullivan, PhD, principal scientist on the project and an associate professor of epidemiology at Rollins School of Public Health at Emory University in Atlanta.
The resource, which was launched in June 2011 by the school, consists of an online map that illustrates the prevalence of HIV in the U.S. and identifies the location of HIV testing and treatment centers, Sullivan said.
“It’s important for primary care physicians to look at the maps and understand [how their community is being impacted] by the national epidemic,” he said.
A limitation of the Archives study is that it focuses on HIV-related deaths in only 26 states, the authors said. But Simard said the study’s researchers also examined data on HIV mortality in the remaining 24 states and the District of Columbia and came up with findings that were similar to those in the Archives report.
“This gives us reassurance to say that while the data [are] not technically nationally representative, the overall trends and message to identify these groups with elevated rates of HIV mortality really applies to” all states, Simard said.