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The actuarial approach, a statistical method originally developed for life insurance risk assessment, is widely used to calculate survival rates in clinical and population studies. This method accounts for participants lost to follow-up or those who die from causes unrelated to the study, ensuring a more accurate representation of survival probabilities.
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Area of Science:

  • Public Health
  • Epidemiology
  • Biostatistics

Background:

  • HIV surveillance data is used to monitor mortality in people with HIV in the US.
  • Age-standardized death rates are the standard metric, but principles are inconsistently applied.
  • Inconsistent age standardization hinders accurate comparisons over time, across jurisdictions, and by characteristics.

Purpose of the Study:

  • To review current age standardization practices for HIV-related mortality in the US.
  • To discuss age standardization principles, particularly for the HIV population.
  • To provide recommendations and report age-standardized death rates in New York City.

Main Methods:

  • Review of current age standardization practices in HIV mortality surveillance.
  • Discussion of age standardization principles relevant to the HIV population.
  • Calculation and reporting of age-standardized death rates for people with and without HIV in New York City (2013-2017).

Main Results:

  • Age-standardized death rates among people with HIV in NYC decreased from 20.8 to 17.1 per 1000 (2013-2017).
  • Age-standardized death rates among people without HIV in NYC decreased from 5.8 to 5.5 per 1000 (2013-2017).
  • The analysis focused on adults aged 18-84 years.

Conclusions:

  • Inconsistent application of age standardization in HIV mortality surveillance undermines its utility.
  • Accurate age standardization is essential for reliable monitoring of HIV-related mortality trends.
  • New York City observed a decline in age-standardized death rates for both people with and without HIV between 2013 and 2017.