HIV mortality trends among the United States population, from 1999-2023: a CDC wonder database study

Despite the progress made in managing HIV, the mortality trends among general population in the US remains understudied. Our aim is to analyse the trends in HIV-related mortality among US residents by demographic characteristics and association with social vulnerability index (SVI).

We abstracted national mortality data from the multiple cause of death files in the CDC WONDER database. The ICD-10 Codes (B20-B24) were used to identify HIV deaths among US population from 1999 to 2023. Trends in age-adjusted mortality rate (AAMR) were assessed using Joinpoint regression analysis. For 10-year increment age-groups, crude mortality rates were reported. Results were expressed as annual percentage changes (APC), average annual percentage changes (AAPC), and 95% confidence intervals (CI). SVI was obtained from CDC for each county.

Between 1999 and 2023, a total of 271,932 HIV-infected patients died within the US (AAMR= 3.4 per 100,000; 95% CI: 3.3-3.5). Overall mortality trends decreased at an annual rate of -4.34% (95% CI: -5.25, -3.41) from 1999 through 2023 in the whole population. Specifically, the trends are higher among males age groups 45-54 years (overall rising in age 65 and above), African Americans, South Region and Large metropolitan areas. States in the top 90th percentile included District of Columbia, Florida, Maryland, Louisiana, New York, and Georgia. Union county followed by Miami-Dade are highly affected within Florida State which ranks second after District of Columbia. SVI was independently associated with HIV mortality with strong association throughout the United States counties.

HIV mortality among US population has decreased overall from 1999 to 2023, but with varying trends by race and ethnicity. This highlights the need for enhanced public health surveillance to better understand the scope of HIV mortality and identify high-risk demographic and regional subgroups for targeted interventions.