Trends and Disparities in Cardiovascular Mortality among HIV-Positive Adults in the United States (2004-2020): A CDC WONDER Database Analysis.

INTRODUCTION

A growing link is observed between cardiovascular disease (CVD) and human immunodeficiency virus (HIV), with more results demonstrating a higher CVD incidence among the HIV population. As the life span of HIV patients rises due to the availability of antiviral treatment, more CVDs and their complications keep unfolding.

METHODS

This study followed a retrospective cohort study design and implemented the CDC WONDER (Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research) platform from 2004 to 2020. It assessed deaths caused by HIV alone and deaths where CVD co-occurred with HIV as per the International Classification of Diseases -10th Revision (ICD-10). The dataset included death certificates from all 50 states and the District of Columbia, involving adults aged 25 years and older. The HIV-related crude and age-adjusted mortality rate (AAMR) per 1,000,000 people was calculated to examine national trends in mortality.

RESULTS

Our study unveiled that CVD and HIV-related deaths reached 50,132 deaths in total, while CVD-related deaths were 24,314,677 in number. The overall age-adjusted mortality rate (AAMR) for CVD and HIV-related deaths among adults decreased from 18.85 (95% CI: 18.23 to 19.47) per 1 million individuals in 2004 to 13.73 (95% CI: 13.27-14.20) per 1 million individuals in 2020, with an average annual percentage change (AAPC) of -2.36 (95% CI: -3.13 to -1.91) (p value<0.00001). AAMRs were highest among Black or African Americans, followed by Hispanic or Latinos and Whites, where the AAMR of all the races decreased to variable degrees from 2004 to 2020, with the decrease most pronounced in Black patients.

DISCUSSION: CVD and HIV-related versus CVD-related AAMR varied based on geographical regions, with the highest CVD and HIV mortality observed in the Northeast. Metropolitan areas exhibited higher CVD and HIV-related AAMRs than non-metropolitan areas throughout the study.

CONCLUSION

Our study highlighted rising mortality rates associated with HIV and CVD-related deaths. These can have multifactorial causes that require prompt investigation. The identification of high-risk communities can provide a general framework for targeted interventions and policies that can mitigate the escalating disease burden and mortality linked with HIV and CVD.