Excess Mortality Among People with HIV in Florida During the Initial Onset of the COVID-19 Pandemic: A Surveillance-Based Analysis.

We aimed to determine differences in the occurrence and timing of all-cause excess mortality among people with HIV (PWH) in Florida early in the COVID-19 pandemic by sex, race and ethnicity, age, rural/urban residence, and neighborhood poverty levels. We used de-identified data from the Florida Department of Health enhanced HIV/AIDS reporting system. Expected numbers of monthly deaths and the 95% upper bound from March to December 2020 were estimated from observed deaths during January 2016-February 2020. The difference between expected and observed deaths was considered excess mortality. We also compared the age-adjusted all-cause mortality rate for PWH in 2020 to the average age-adjusted mortality rate for 2016 - 2019 using direct standardization. During the observation period from 2016 to 2020, there were a total of 9843 deaths among PWH. From March to December 2020, there were an estimated 314 excess deaths, and 61 excess deaths above the estimated 95% upper bound. The highest excess mortality occurred in July and August and was primarily due to increases in COVID-19 deaths. All groups of PWH experienced excess mortality except rural residents. Deaths among female, non-Hispanic Black, andurban-residing PWH exceeded the 95% upper bound of expected deaths. Compared to males, female PWH experienced a greater absolute increase in the 2020 age-adjusted mortality rate. Non-Hispanic Black and non-Hispanic White PWH had larger absolute and relative increases in the 2020 age-adjusted mortality rate compared to Hispanic PWH. Findings related to excess mortality should be considered in pandemic planning and preparation efforts for vulnerable groups like PWH.