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Addict Sci Clin Pract. 2018 Jan 22;13(1):2. doi: 10.1186/s13722-017-0103-z.

Racial/ethnic differences in the association between alcohol use and mortality among men living with HIV.

Author information

1
Department of Health Services, Magnuson Health Sciences Center, University of Washington School of Public Health, 1959 NE Pacific St, Box 357660, Seattle, WA, 98195-7660, USA. kbensley@uw.edu.
2
VA Health Services Research and Development (HSRD) Denver Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, 1660 S. Columbian Way, Mailstop S-152, Seattle, WA, 98108, USA. kbensley@uw.edu.
3
VA Connecticut Healthcare System, West Haven Campus, 950 Campbell Avenue, West Haven, CT, 06516, USA.
4
Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
5
Salt Lake City VA, 500 Foothill Dr, Salt Lake City, UT, 84148, USA.
6
University of Utah, 201 Presidents Cir, Salt Lake City, UT, 84112, USA.
7
VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA.
8
University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA.
9
National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Ln, Rockville, MD, 20852, USA.
10
Rutgers University, 7 College Ave, New Brunswick, NJ, 08901, USA.
11
Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
12
Brown University School of Public Health, 121 S Main St, Providence, RI, 02903, USA.
13
Department of Health Services, Magnuson Health Sciences Center, University of Washington School of Public Health, 1959 NE Pacific St, Box 357660, Seattle, WA, 98195-7660, USA.
14
University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.
15
VA Health Services Research and Development (HSRD) Denver Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, 1660 S. Columbian Way, Mailstop S-152, Seattle, WA, 98108, USA.

Abstract

BACKGROUND:

Increasing alcohol use is associated with increased risk of mortality among patients living with HIV (PLWH). This association varies by race/ethnicity among general outpatients, but racial/ethnic variation has not been investigated among PLWH, among whom racial/ethnic minorities are disproportionately represented.

METHODS:

VA electronic health record data from the Veterans Aging Cohort Study (2008-2012) were used to describe and compare mortality rates across race/ethnicity and levels of alcohol use defined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. Within each racial/ethnic group, Cox proportional hazards models, adjusted for age, disease severity, and comorbidities, compared mortality risk for moderate-risk (AUDIT-C = 4-7) and high-risk (AUDIT-C ≥ 8) relative to lower-risk (AUDIT-C = 1-3) alcohol use.

RESULTS:

Mean follow-up time among black (n = 8518), Hispanic (n = 1353), and white (n = 7368) male PLWH with documented AUDIT-C screening (n = 17,239) was 4.3 years. Black PLWH had the highest mortality rate among patients reporting lower-risk alcohol use (2.9/100 person-years) relative to Hispanic and white PLWH (1.8 and 2.3, respectively) (p value for overall comparison = 0.011). Mortality risk was increased for patients reporting high-risk relative to lower-risk alcohol use in all racial/ethnic groups [black adjusted hazard ratio (AHR) = 1.36, 95% confidence interval (CI) 1.12-1.66; Hispanic AHR = 2.18, 95% CI 1.30-3.64; and white AHR = 2.04, 95% CI 1.61-2.58]. For only white PLWH, mortality risk was increased for patients reporting moderate-relative to lower-risk alcohol use (black AHR = 1.09, 95% CI 0.93-1.27; Hispanic AHR = 1.36, 95% CI 0.89-2.09; white AHR = 1.51, 95% CI 1.28-1.77).

CONCLUSION:

Among all PLWH, mortality risk was increased among patients reporting high-risk alcohol use across all racial/ethnic groups, but mortality risk was only increased among patients reporting moderate-risk relative to lower-risk alcohol use among white PLWH, and black patients appeared to have higher mortality risk relative to white patients at lower-risk levels of alcohol use. Findings of the present study further underscore the need to address unhealthy alcohol use among PLWH, and future research is needed to understand mechanisms underlying observed differences.

KEYWORDS:

Alcohol use; HIV; Mortality risk; Racial/ethnic disparities; Veterans

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