Estimating Excess Mortality Among People Living with Human Immunodeficiency Virus During the Coronavirus Disease 2019...

Understanding the syndemic effects of COVID-19 and Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome can inform future public health preparedness. This study quantifies the all-cause excess death rate (EDR) of people living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (PWHA) during the 2020 to 2022 COVID-19 pandemic in the United States, including stratifications by sex, age, race/ethnicity, and region.

Using publicly available data from the CDC AtlasPlus dashboard, we employed an ensemble n-subepidemic modeling framework ( SubEpiPredict toolbox). This dynamic parametric approach is well-suited for counterfactual forecasting with relatively short time series and was used to generate expected deaths among PWHA for 2020 to 2022 based on pre-pandemic trends. The models were calibrated using 12 years of pre-pandemic mortality trends (2008-2019), with the median EDR calculated as observed minus forecasted death rates.

Overall excess mortality among PWHA was estimated at 7783 crude excess deaths (95% prediction interval: 5098-10,525), corresponding to 2.77 excess deaths per 100,000 people (95% prediction interval: 1.81-3.75), with the largest burden observed in 2021. EDRs were highest among males (3.39), age 55 to 64 (4.94), multiracial (12.82), and Northeast (4.12) groups. The largest crude number of excess deaths occurred among males (4692), aged 65 years and older (2560), Black/African Americans (3969), and Southern (4025) groups.

These systematic, model-based results reveal stark heterogeneities among PWHA by exposing recent mortality patterns that may not be captured by disease-specific mortality reporting alone. These findings provide a robust, reproducible benchmark for assessing pandemic-related disparities and can inform future public health resource allocation and tailored interventions for vulnerable populations.