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

Area of Science:

• Public Health
• Epidemiology
• Health Policy

Background:

• Mortality rates for people with diagnosed HIV infection (PLWH) in the U.S. are nearly double that of the general population.
• Identifying modifiable factors influencing mortality among PLWH is crucial for public health interventions.

Purpose of the Study:

• To identify amendable factors that state public health programs can influence to reduce mortality among PLWH.
• To assess the association between state-level mortality rates among PLWH and factors like viral suppression, healthcare coverage, and anti-discrimination laws.

Main Methods:

• Generalized estimating equations (GEE) were used to analyze age-group-specific models (24-34, 35-54, ≥55 years) from 2010-2014.
• Data from the National HIV Surveillance System and state-level amendable factors were utilized.
• Sociodemographic non-modifiable factors were controlled for in the analysis.

Main Results:

• Higher viral suppression among Ryan White HIV/AIDS Program (RWHAP) clients was associated with 3-5% lower mortality rates across all age groups.
• Increased healthcare coverage correlated with 4-11% lower mortality rates in older age groups (35-54 and ≥55 years).
• States with more comprehensive anti-discrimination laws showed a 2-3% reduction in mortality rates among older PLWH (35-54 and ≥55 years).

Conclusions:

• State-level mortality among PLWH is associated with higher healthcare coverage, stronger anti-discrimination laws, and greater viral suppression.
• Public health programs and policies can effectively target these factors to reduce mortality in the PLWH population.
• Interventions focusing on healthcare access, legal protections, and treatment adherence can improve health outcomes for PLWH.