The comparative mortality figure (CMF) is the expected number of deaths in the standard population compared with those observed. We assessed state-based CMFs for people with HIV infection to allow standardized assessment of mortality in all states.
Methods.
We used National HIV Surveillance System data to compute CMFs for people diagnosed with HIV and AIDS from 2001 to 2010 who met the CDC HIV case definition; were alive on December 31, 2009; and died during 2010.
Results.
In 33 U.S. states with name-based HIV reporting since 2001, the 2010 CMF for people with an HIV diagnosis was 2.8 compared with 4.5 for those with an AIDS diagnosis. CMFs for males were higher than for females (3.4 vs. 3.1) and black people had higher CMFs than white people for HIV (3.2 vs. 2.2) and AIDS (4.7 vs. 4.3). CMFs by state ranged from 0.9 to 4.2 for HIV and 1.9 to 9.7 for AIDS. In 50 states and the District of Columbia with AIDS reporting, CMFs for males and females were similar (4.5 and 4.6, respectively), CMFs for black people remained higher than for white people (5.0 and 3.9, respectively), and the range for states remained broad (1.2–9.4).
Conclusion.
State mortality figures varied based on population composition and disease stage at diagnosis, possibly indicating a need for state-specific testing, linkage to care, and viral suppression strategies to reduce mortality.
References
1.
Centers for Disease Control and Prevention (US), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. ATLAS online database [cited 2014 Dec 29. Available from: URL: http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html.
2.
Centers for Disease Control and Prevention (US), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas. HIV Surveill Rep2013;23:1–84.
3.
FentonKA, Changing epidemiology of HIV/AIDS in the United States: Implications for enhancing and promoting HIV testing strategies. Clin Infect Dis2007;45:S213–20.
4.
MeyerVA, Screening for HIV: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med2013;159:1–36.
5.
Vital signs: HIV testing and diagnosis among adults: United States, 2001–2009. MMWR Morb Mortal Wkly Rep2010;59(47):1550–5.
6.
JohnsonA SatcherHeitgerdJKoenigLJVanHandelMBransonBMConnellyE, Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep2006;55(RR-14):1–17.
7.
Centers for Disease Control and Prevention (US), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. National HIV prevention progress report, 2013 [cited 2013 Dec 12]. Available from: URL: http://www.cdc.gov/hiv/policies/npr.
8.
Centers for Disease Control and Prevention (US). High-impact HIV prevention: CDC/s approach to reducing HIV infections in the United States [cited 2013 Nov 9. Available from: URL: http://www.cdc.gov/hiv/strategy/hihp.
HannaDBSelikRMTangTGangeSJ, Disparities among U.S. states in HIV-related mortality in persons with HIV infection, 2001–2007. AIDS2012;26:95–103.
11.
InskipHBeralVFraserPHaskeyJ.Methods for age-adjustment of rates. Stat Med1983;2:455–66.
12.
ChakrabortyMDassKK, Comparative mortality ratio—a health index. Indian J Public Health1985;29:23–8.
13.
JuliousSANichollJGeorgeS.Why do we continue to use standardized mortality ratios for small area comparisons?J Public Health Med2001;23:40–6.
14.
LeeWC, Standardization using the harmonically weighted ratios: Internal and external comparisons. Stat Med2002;21:247–61.
15.
AlexopoulosECMessoloraFTanagraD.Comparative mortality ratios of cancer among men in Greece across broad occupational groups. Int Arch Occup Environ Health2011;84:943–9.
16.
BorrellCPlasenciaAPasarinIOrtunV.Widening social inequalities in mortality: The case of Barcelona, a southern European city. J Epidemiol Community Health1997;51:659–67.
17.
GjesdalSRingdalPRHaugKMaelandJGVollsetSEAlexandersonK.Mortality after long-term sickness absence: Prospective cohort study. Eur J Public Health2008;18:517–21.
18.
LuskyAGurvitzRBarellV.Variation in mortality rates in Tel Aviv region municipalities. Isr J Med Sci1994;30:690–8.
19.
TrautnerCIcksAHaastertBPlumFBergerMGianiG.Diabetes as a predictor of mortality in a cohort of blind subjects. Int J Epidemiol1996;25:1038–43.
20.
National Technical Information Service. Social Security Administration/s death master file [cited 2015 Jan 5. Available from: URL: https://dmf.ntis.gov/recordlayout.html.
21.
Centers for Disease Control and Prevention (US). National death index [cited 2012 Oct 23. Available from: URL: http://www.cdc.gov/nchs/ndi.htm.
22.
Centers for Disease Control and Prevention (US) and Council of State and Territorial Epidemiologists. Technical guidance for HIV/AIDS surveillance programs, volume I: Policies and procedures. Atlanta: CDC; 2005.
SchneiderEWhitmoreSGlynnMKDominguezKMitschAMcKennaMT, Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years—United States, 2008. MMWR Recomm Rep2008;57(RR-10):1–8.
26.
National Center for Health Statistics (US). CDC WONDER: About multiple cause of death, 1999–2012 [cited 2013 May 3. Available from: URL: http://wonder.cdc.gov/mcd-icd10.html.
27.
Centers for Disease Control and Prevention (US), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2011. HIV Surveill Rep2013;18:1–47.
28.
Centers for Disease Control and Prevention (US), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 U.S. dependent areas—2010. HIV Surveill Rep2013;18(No. 2, part B):1–25.
HallHIFrazierELRhodesPHoltgraveDRFurlow-ParmleyCTangT, Differences in human immunodeficiency virus care and treatment among subpopulations in the United States. JAMA Intern Med2013;173:1337–44.
31.
HallHIMcDavidKLingQSloggettA.Determinants of progression to AIDS or death after HIV diagnosis, United States, 1996 to 2001 [published erratum appears in Ann Epidemiol2007;17:642]. Ann Epidemiol2006;16:824–33.
32.
GrayKMTangTShouseLLiJMerminJHallHI, Using the HIV surveillance system to monitor the National HIV/AIDS Strategy. Am J Public Health2013;103:141–7.
33.
HallHIGrayKMTangTLiJShouseLMerminJ.Retention in care of adults and adolescents living with HIV in 13 U.S. areas. J Acquir Immune Defic Syndr2012;60:77–82.
34.
DeNavas-WaltCBernadetteBDSmithJC, Current Population Reports, P60–243. Income, poverty, and health insurance coverage in the United States: 2011. Washington: Government Printing Office (US); 2012.
35.
HorstmanEBrownJIslamFBuckJAginsBD, Retaining HIV-infected patients in care: Where are we?Where do we go from here? Clin Infect Dis2010;50:752–61.
36.
WohlARGalvanFHMyersHFGarlandWGeorgeSWittM, Do social support, stress, disclosure and stigma influence retention in HIV care for Latino and African American men who have sex with men and women? AIDS Behav2011;15:1098–110.
37.
McNairyMLEl-SadrWM, The HIV care continuum: No partial credit given. AIDS2012;26:1735–8.
38.
KarchDLChenMTangT.Evaluation of the National Human Immunodeficiency Virus Surveillance System for the 2011 diagnosis year. J Public Health Manag Pract2014;20:598–607.
39.
Department of Health and Human Services (US), Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Rockville (MD): HHS; 2013. Also available from: URL: http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf [cited 2013 Sep 3].
