Life-expectancy disparities among adults with HIV in the United States and Canada: The impact of a reduction in drug- and alcohol-related deaths using the lives saved simulation model

Keri N. Althoff*, Aruna Chandran, Jinbing Zhang, Wendy Miranda Arevalo, Stephen J. Gange, Timothy R. Sterling, M. John Gill, Amy C. Justice, Frank J. Palella, Peter F. Rebeiro, Michael J. Silverberg, Angel M. Mayor, Michael A. Horberg, Jennifer E. Thorne, Charles S. Rabkin, W. Christopher Mathews, Marina B. Klein, Elizabeth Humes, Jennifer Lee, Robert HoggRichard D. Moore

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

Improvements in life expectancy among people living with human immunodeficiency virus (PLWH) receiving antiretroviral treatment in the United States and Canada might differ among key populations. Given the difference in substance use among key populations and the current opioid epidemic, drug- and alcohol-related deaths might be contributing to the disparities in life expectancy. We sought to estimate life expectancy at age 20 years in key populations (and their comparison groups) in 3 time periods (2004-2007, 2008-2011, and 2012-2015) and the potential increase in expected life expectancy with a simulated 20% reduction in drug- and alcohol-related deaths using the novel Lives Saved Simulation model. Among 92,289 PLWH, life expectancy increased in all key populations and comparison groups from 2004-2007 to 2012-2015. Disparities in survival of approximately a decade persisted among black versus white men who have sex with men and people with (vs. without) a history of injection drug use. A 20% reduction in drug- and alcohol-related mortality would have the greatest life-expectancy benefit for black men who have sex with men, white women, and people with a history of injection drug use. Our findings suggest that preventing drug- and alcohol-related deaths among PLWH could narrow disparities in life expectancy among some key populations, but other causes of death must be addressed to further narrow the disparities.

Original languageEnglish (US)
Pages (from-to)2097-2109
Number of pages13
JournalAmerican journal of epidemiology
Volume188
Issue number12
DOIs
StatePublished - Dec 31 2019

Funding

New Haven, Connecticut (Amy C. Justice); Veterans Affairs Connecticut Healthcare System, New Haven, Connecticut (Amy C. Justice); Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Frank J. Palella Jr.); Division of Research, Kaiser Permanente Northern California, Oakland, California (Michael J. Silverberg); Department of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico (Angel M. Mayor); Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland (Michael A. Horberg); Wilmer Eye Institute, School of Medicine, Johns Hopkins University, Baltimore, Maryland (Jennifer E. Thorne); National Cancer Institute, Bethesda, Maryland (Charles S. Rabkin); Department of Medicine, University of California San Diego, San Diego, California (W. Christopher Mathews); Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada (Marina B. Klein); Department of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (Robert Hogg); British Columbia Centre for HIV/AIDS Excellence, Vancouver, British Columbia, Canada (Robert Hogg); and Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland (Richard D. Moore). This work was supported by the National Institutes of Health (grants U01AI069918, F31AI124794, F31DA037788, G12MD007583, K01AI093197, K01AI131895, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, M01RR000052, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01CA165937, R01DA011602, R01DA012568, R01AG053100, R24AI067039, U01AA013566, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI037984, U01AI038855, U01AI038858, U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA03629, U01DA036935, U01HD032632, U10EY008057, U10EY008052, U10EY008067, U24AA020794,U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM1AI035043, Z01CP010214, and Z01CP010176), the Centers for Disease Control and Prevention (contracts CDC-200-2006-18797 and CDC-200-2015-63931), the Agency for Healthcare Research and Quality (contract 90047713), the Health Resources and Services Administration (contract 90051652), the Canadian Institutes of Health Research (grants CBR-86906, CBR-94036, HCP-97105, and TGF-96118), the Ontario Ministry of Health and Long Term Care, and the Government of Alberta (Canada). Additional support was provided by the National Cancer Institute, National Institute of Mental Health, and National Institute on Drug Abuse, as well as the Johns Hopkins Center for AIDS Research (grant P30AI094189).

Keywords

  • HIV
  • Hispanic adults
  • black women
  • drug- and alcohol-related deaths
  • health disparities
  • life expectancy
  • men who have sex with men
  • people who inject drugs

ASJC Scopus subject areas

  • General Medicine

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