Causes of Death and Mortality Trends among Utah HIV/AIDS Cases, 2000-2011 Anne Burke, MS, Matthew S....
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Causes of Death and Mortality Trends among Utah HIV/AIDS Cases, 2000-2011 Anne Burke, MS, Matthew S. Mietchen, MPH, David Jackson, MPH, Allyn K. Nakashima, MD Utah Department of Health, Salt Lake City, UT With the advent of highly active antiretroviral therapy (HAART), people living with HIV/AIDS (PLWHA) are living longer and the incidence and causes of death have changed. Understanding these changes will help treatment and prevention programs to support the evolving needs of PLWHA. • HIV/AIDS cases in Utah are living longer with lower rates of mortality due to AIDS-defining illnesses. With this decline, the proportion of deaths attributable to other causes has increased. • The increase in the proportion of deaths due to malignant neoplasms suggest that cancer screening is an important clinical consideration in this population. • Suicides increased significantly as a cause of death during this time period. Suicides peaked in 2008. Ensuring sustained access to mental health services will be important in the effort to decrease mortality among HIV/AIDS cases in Utah. • Although HAART may prolong lower the risk of HIV disease progression, it is not without its risks. • Frequently identified underlying causes of death included cardio-cerebrovascular events. Individuals with HIV may be at increased risk for cardiovascular disease due to the effects of HAART and behavioral factors. • Poisonings which were accidental, intentional, or of undetermined intent were frequently identified as the underlying cause of death; however, deaths associated with narcotics decreased significantly. Monitoring the clinical implication of HAART is an important consideration. • These data are limited by a small sample size. Utah is a low morbidity state and the inclusion of only deaths linked to Utah DCR may exclude deaths in other states. Discussion Results • Death certificate records from 2000-2011 were obtained from the Utah Office of Vital Records and Statistics. • A data set was generated from the Utah Enhanced HIV/AIDS Reporting System (eHARS). • Electronic record linkage (LinkKing) was utilized to match HIV cases reported in eHARS with Utah death certificate records (DCR). The variables used for record linkage were first and last name, gender, date of birth, and Social Security Number (SSN). • Death certificate records were subset to include only those which matched to a Utah HIV/AIDS cases as reported to eHARS. • A total of 191 deaths matched to reported cases and were used for the subsequent analysis. • Underlying cause of and age at death were identified. ICD-10 codes for underlying cause of death were categorized as follows: HIV and AIDS-related causes according to Centers for Disease Control and Prevention (CDC) criteria; liver disease, including hepatitis C and B and alcohol-related cirrhosis and hepatic failure; chronic conditions; other infections; suicide; deaths which were Introduction • The data for this analysis was provided by the Utah Department of Health and Mylitta Barrett from the Office of Vital Records and Statistics. • This study/report was supported in part by the CDC Cooperative Agreement Award No. 1 U62 PS004023-01. Acknowledgements The objective of this analysis was to determine the causes of death and mortality trends among HIV/AIDS cases in Utah between 2000 and 2011. Contact Anne Burke, MS Utah Department of Health Bureau of Epidemiology [email protected] Matthew Mietchen, MPH Utah Department of Health Bureau of Epidemiology [email protected] Methods Purpose Figure 1: Percentage of Deaths with an Underlying Cause Attributable to AIDS- Defining Illnesses among 191 Utah HIV/AIDS Cases by Year, 2000-2011 Table 1: Frequencies of Underlying Causes of Death Attributable AIDS-Defining Illnesses among 191 Utah HIV/AIDS Cases, 2000-2011 0 20 40 60 80 100 Percentage Z=1.69 p=0.05 Non-AIDS-Defining Underlying Causes of Death Test for Trend from 2000-2011 N=80 N (%) Z- Score p- value Chronic conditions 23 (12.0) 0.63 0.26 Cardio- and cerebrovascular disease 12 (6.3) Kidney disease 4 (2.1) Respiratory disease 3 (1.6) Diabetes 2 (1.1) Metabolic disease 2 (1.1) Deaths of accidental or undetermined intent 15 (7.9) -0.99 0.16 Poisonings 9 (4.7) Other deaths 6 (3.1) Suicide 9 (4.7) -2.91 <0.01 Malignant neoplasms 9 (4.7) -1.77 0.04 Lung and esophageal 3 (1.6) Colon and anal 3 (1.6) Bladder 1 (0.5) Breast 1 (0.5) Underlying Cause of Death N (%) HIV and AIDS-defining illnesses 111 (58.1) HIV* 90 (47.1) Non-Hodgkin’s lymphoma 7 (3.7) Kaposi’s sarcoma 4 (2.1) Atypical mycobacterial infection 4 (2.1) Pneumocystis carinii pneumonia 3 (1.6) Cytomegalovirus disease 1 (0.5) HIV encephalopathy 1 (0.5) Wasting 1 (0.5) *HIV includes ICD-10 codes B20-B24 for HIV not specifying an infection or disease Table 2: Frequencies of Underlying Causes of Death Other Than AIDS- Defining Illnesses among 191 Utah HIV/AIDS Cases, 2000-2011 35 40 45 50 Age at Death F=4.29 p=0.04 0 10 20 Percentage 0 10 20 30 Percentage 0 5 10 15 Percentage Figure 3: Substance Abuse Figure 4: Suicide Figure 5: Average Age at Death among Utah HIV/AIDS cases by Year, 2000-2011 Figure 2: Malignant Neoplasms Figures 2-4: Percentage of Deaths with an Underlying Cause Attributable to Malignant Neoplasms, Substance Abuse, and Suicide among 191 Utah HIV/AIDS Cases by Year, 2000-2011
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Transcript of Causes of Death and Mortality Trends among Utah HIV/AIDS Cases, 2000-2011 Anne Burke, MS, Matthew S....
Causes of Death and Mortality Trends among Utah HIV/AIDS Cases, 2000-2011
Anne Burke, MS, Matthew S. Mietchen, MPH, David Jackson, MPH, Allyn K. Nakashima, MDUtah Department of Health, Salt Lake City, UT
With the advent of highly active antiretroviral therapy (HAART), people living with HIV/AIDS (PLWHA) are living longer and the incidence and causes of death have changed. Understanding these changes will help treatment and prevention programs to support the evolving needs of PLWHA.
• HIV/AIDS cases in Utah are living longer with lower rates of mortality due to AIDS-defining illnesses. With this decline, the proportion of deaths attributable to other causes has increased.
• The increase in the proportion of deaths due to malignant neoplasms suggest that cancer screening is an important clinical consideration in this population.
• Suicides increased significantly as a cause of death during this time period. Suicides peaked in 2008. Ensuring sustained access to mental health services will be important in the effort to decrease mortality among HIV/AIDS cases in Utah.
• Although HAART may prolong lower the risk of HIV disease progression, it is not without its risks.
• Frequently identified underlying causes of death included cardio-cerebrovascular events. Individuals with HIV may be at increased risk for cardiovascular disease due to the effects of HAART and behavioral factors.
• Poisonings which were accidental, intentional, or of undetermined intent were frequently identified as the underlying cause of death; however, deaths associated with narcotics decreased significantly. Monitoring the clinical implication of HAART is an important consideration.
• These data are limited by a small sample size. Utah is a low morbidity state and the inclusion of only deaths linked to Utah DCR may exclude deaths in other states.
DiscussionResults
• Death certificate records from 2000-2011 were obtained from the Utah Office of Vital Records and Statistics.
• A data set was generated from the Utah Enhanced HIV/AIDS Reporting System (eHARS).
• Electronic record linkage (LinkKing) was utilized to match HIV cases reported in eHARS with Utah death certificate records (DCR). The variables used for record linkage were first and last name, gender, date of birth, and Social Security Number (SSN).
• Death certificate records were subset to include only those which matched to a Utah HIV/AIDS cases as reported to eHARS.
• A total of 191 deaths matched to reported cases and were used for the subsequent analysis.
• Underlying cause of and age at death were identified. ICD-10 codes for underlying cause of death were categorized as follows: HIV and AIDS-related causes according to Centers for Disease Control and Prevention (CDC) criteria; liver disease, including hepatitis C and B and alcohol-related cirrhosis and hepatic failure; chronic conditions; other infections; suicide; deaths which were accidental or of undetermined intent; malignant neoplasms; substance abuse; and unknown.
• Trends in the frequency of underlying cause of death and age at death by year were compared using the Cochran-Armitage and ANOVA test for trend, respectively.
Introduction
• The data for this analysis was provided by the Utah Department of Health and Mylitta Barrett from the Office of Vital Records and Statistics.
• This study/report was supported in part by the CDC Cooperative Agreement Award No. 1 U62 PS004023-01.
Acknowledgements
The objective of this analysis was to determine the causes of death and mortality trends among HIV/AIDS cases in Utah between 2000 and 2011.
ContactAnne Burke, MSUtah Department of HealthBureau of [email protected]
Matthew Mietchen, MPHUtah Department of HealthBureau of [email protected]
Methods
Purpose
Figure 1: Percentage of Deaths with an Underlying Cause Attributable to AIDS-Defining Illnesses among 191 Utah HIV/AIDS Cases by Year, 2000-2011
Table 1: Frequencies of Underlying Causes of Death Attributable AIDS-Defining Illnesses among 191 Utah HIV/AIDS Cases, 2000-2011
20002001
20022003
20042005
20062007
20082009
20102011
0102030405060708090
Perc
enta
ge
Z=1.69p=0.05
Non-AIDS-Defining Underlying Causes of Death
Test for Trend from 2000-2011
N=80 N (%) Z-Score p-valueChronic conditions 23 (12.0) 0.63 0.26 Cardio- and cerebrovascular disease
12 (6.3)
Kidney disease 4 (2.1) Respiratory disease 3 (1.6) Diabetes 2 (1.1) Metabolic disease 2 (1.1) Deaths of accidental or undetermined intent
15 (7.9) -0.99 0.16
Poisonings 9 (4.7) Other deaths 6 (3.1) Suicide 9 (4.7) -2.91 <0.01Malignant neoplasms 9 (4.7) -1.77 0.04 Lung and esophageal 3 (1.6) Colon and anal 3 (1.6) Bladder 1 (0.5) Breast 1 (0.5) Leukemia 1 (0.5) Substance Abuse 8 (4.2) 1.88 0.04 Narcotics 6 (3.1) Alcohol 1 (0.5) Tobacco 1 (0.5) Liver Disease 7 (3.7) -1.51 0.06 Cirrhosis 4 (2.1) Hepatitis 2 (1.1) Hepatic failure 1 (0.5) Unknown 5 (2.6) 0.59 0.28Other infections 4 (2.1) 0.23 0.44 Influenza 2 (1.1) Septicemia 2 (1.1)
Underlying Cause of Death N (%) HIV and AIDS-defining illnesses 111 (58.1) HIV* 90 (47.1) Non-Hodgkin’s lymphoma 7 (3.7) Kaposi’s sarcoma 4 (2.1) Atypical mycobacterial infection 4 (2.1) Pneumocystis carinii pneumonia 3 (1.6) Cytomegalovirus disease 1 (0.5) HIV encephalopathy 1 (0.5) Wasting 1 (0.5)*HIV includes ICD-10 codes B20-B24 for HIV not specifying an infection or diseaseTable 2: Frequencies of Underlying Causes of Death
Other Than AIDS-Defining Illnesses among 191 Utah HIV/AIDS Cases, 2000-2011
20002001
20022003
20042005
20062007
20082009
20102011
35
40
45
50
Age
at D
eath
F=4.29p=0.04
20002001
20022003
20042005
20062007
20082009
20102011
05
101520
Perc
enta
ge
20002001
20022003
20042005
20062007
20082009
20102011
05
1015202530
Perc
enta
ge
20002001
20022003
20042005
20062007
20082009
20102011
0
5
10
15
Perc
enta
ge
Figure 3: Substance Abuse
Figure 4: Suicide
Figure 5: Average Age at Death among Utah HIV/AIDS cases by Year, 2000-2011
Figure 2: Malignant Neoplasms
Figures 2-4: Percentage of Deaths with an Underlying Cause Attributable to Malignant Neoplasms, Substance Abuse, and Suicide among 191 Utah HIV/AIDS Cases by Year, 2000-2011
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