Influence of geographical origin and ethnicity on mortality in patients on antiretroviral therapy in Canada, Europe and the United States

• Published in: Clinical Infectious Diseases
• Main Authors: , May, Margaret T, Sterne, Jonathan
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2013
• Subjects: Canada; First Nations
• Online Access: https://hdl.handle.net/1983/8faa7b4f-633a-4837-a3ae-b60cc601e1dc; https://research-information.bris.ac.uk/en/publications/8faa7b4f-633a-4837-a3ae-b60cc601e1dc; https://doi.org/10.1093/cid/cit111

Background. To assess differences in all-cause mortality, as well as AIDS and non-AIDS death rates, among patients started on ART according to their geographical origin (GO) and ethnicity/race (E/R) in Europe, Canada and the US. Methods. Collaboration of cohort studies of HIV-positive subjects who have initiated ART. We categorized GO and E/R in data from 19 cohort studies (ART Cohort Collaboration) from Europe, the United States and Canada. Adjusted mortality hazard ratios (HRa) were estimated using Cox regression using a competing risk frame-work to estimate adjusted subdistribution Hazard Ratios (sHRa). Results. Of 46,648 European patients, 16.3% were from Sub-Saharan Africa (SSA), 5.1% Caribbean & Latin America, 1.7% North-Africa and 1.6% Asia/West; of 1,371 from Canada, 14.9% First-Nations and 22.4% migrants and of 7,742 from North America, 55.5% were African-American, 6.6% Hispanics. Migrants from SSA (HRa 0.79 95%CI: 0.68-0.92) and Asia/West (HRa 0.62 95%CI: 0.41-0.92) had lower mortality than Europeans; these differences appeared mainly attributable to lower non-AIDS mortality. Mortality in Canadian First-Nations (HRa 1.48 95%CI: 0.96-2.29) was higher than White Canadians', both for AIDS and non-AIDS mortality rates. In US, mortality was higher in African-Americans compared to whites and HRa changed over time (p value for interaction 0.013) becoming larger with increasing time from ART initiation. For African-Americans and Hispanics, AIDS mortality sHRa increased compared to whites with time since ART initiation. Conclusions. The lower mortality observed in migrants suggests "healthy migrant" effects whereas the higher mortality in First-Nations and African-Americans in North-America suggests social inequality gaps.