Demographic Factors and Trends Associated with Mortality After AIDS Diagnosis in Puerto Rico

Millions of people have died from AIDS-related illnesses since the start of the epidemic. The objective of this study is to determine the relationship between life years lost and demographic factors in the subset of individuals in Puerto Rico with advanced HIV disease, i.e., who received a diagnosis of AIDS, and to evaluate trends in poverty, age, and number of diagnoses and deaths over this timeframe.

We identified 3624 individuals diagnosed with AIDS who received services under the Eligible Metropolitan Area (EMA) of San Juan, Puerto Rico, between 2000-2020, and correlated demographic factors with AIDS descriptive statistics using a retrospective cohort study design. We used socioeconomic characteristics to describe the population, estimated the life years lost (LYL) compared with the life expectancy of the general population of Puerto Rico at a given age as the null model, and evaluated the relationship of demographic variables with LYL, as well as trends in poverty and age/number of deaths/diagnoses over time.

More life years are lost with earlier AIDS onset, and there is also an association between LYL and the level of poverty, documented mode of transmission, and insurance status. LYL were higher among AIDS patients with lower income, with perinatal transmission, and among those without insurance in the age bracket of 40-49 years. No relationship between LYL and gender was detected. Moreover, over the years included in the timeframe of this study, certain trends emerged: we observed a greater proportion of AIDS to HIV diagnoses over time; HIV/AIDS diagnoses and deaths occurred on average at a higher age; the number of diagnoses per year initially rose over time and then declined; and the number of deaths per year as well as the poverty level in those diagnosed with HIV/AIDS increased over time.

This study demonstrates the continued recent impact of the HIV epidemic specifically on those with advanced disease (AIDS), and further reaffirms the importance of treatment and prevention as well as demographic and social determinants of health, including age, poverty level, insurance status, and lifestyle, highlighting the disproportionate burden of HIV/AIDS among those with greater levels of poverty.