Format

Send to

Choose Destination
BMC Infect Dis. 2018 Aug 28;18(1):428. doi: 10.1186/s12879-018-3336-x.

Excess mortality related to circulatory system diseases and diabetes mellitus among Italian AIDS patients vs. non-AIDS population: a population-based cohort study using the multiple causes-of-death approach.

Author information

1
Centro Operativo AIDS, Istituto Superiore di Sanità, via Regina Elena 299, 00161, Rome, Italy.
2
Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano, IRCCS, via Gallini 2, 33081, Aviano, PN, Italy.
3
Integrated system for health, social assistance, welfare and justice, Istituto Nazionale di Statistica, viale Liegi 13, 00198, Rome, Italy.
4
Scientific Directorate, Centro di Riferimento Oncologico di Aviano, IRCCS, via Gallini 2, 33081, Aviano, PN, Italy. zucchetto.epi@cro.it.

Abstract

BACKGROUND:

Chronic diseases, chiefly cancers and circulatory system diseases (CSDs), have become the leading non-AIDS-related causes of death among HIV-infected people, as in the general population. After our previous report of an excess mortality for several non-AIDS-defining cancers, we now aim to assess whether people with AIDS (PWA) experience also an increased mortality for CSDs and diabetes mellitus (DM), as compared to the non-AIDS general population (non-PWA).

METHODS:

A nationwide, population-based, retrospective cohort study was conducted including 5285 Italians, aged 15-74 years, who were diagnosed with AIDS between 2006 and 2011. Multiple cause-of-death (MCoD) data, i.e. all conditions reported in death certificates, were retrieved through record-linkage with the National Register of Causes of Death up to 2011. Using MCoD data, sex- and age-standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated by dividing the observed number of PWA reporting a specific disease among MCoD to the expected number, estimated on the basis of mortality rates (based on MCoD) of non-PWA.

RESULTS:

Among 1229 deceased PWA, CSDs were mentioned in 201 (16.4%) certificates and DM in 46 (3.7%) certificates among the various causes of death. These values corresponded to a 13-fold higher mortality related to CSDs (95% CI 10.8-14.4) and DM (95% CI: 9.5-17.4) as compared to 952,019 deceased non-PWA. Among CSDs, statistically significant excess mortality emerged for hypertension (23 deaths, SMR = 6.3, 95% CI: 4.0-9.4), ischemic heart diseases (39 deaths, SMR = 6.1, 95% CI: 4.4-8.4), other forms of heart diseases (88 deaths, SMR = 13.4, 95% CI: 10.8-16.5), and cerebrovascular diseases (42 deaths, SMR = 13.4, 95% CI: 9.7-18.2). The SMRs were particularly elevated among PWA aged < 50 years and those infected through drug injection.

CONCLUSIONS:

The use of MCoD data disclosed the fairly high mortality excess related to several CSDs and DM among Italian PWA as compared to non-PWA. Study findings also indicate to start preventive strategies for such diseases at a younger age among AIDS patients than in the general population and with focus on drug users.

KEYWORDS:

Circulatory system diseases; Diabetes mellitus; HIV/AIDS; Multiple causes of death; Standardized mortality ratio

PMID:
30153797
PMCID:
PMC6114052
DOI:
10.1186/s12879-018-3336-x
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center