Impacts of overdose and socio-structural factors on recent mortality among people living with HIV in British Columbia, Canada.

Abstract

Objective: We characterized sociodemographic and behavioural factors associated with mortality among people living with HIV (PLWH) in British Columbia (BC), Canada.

Design: We used purposive sampling to recruit a representative cohort of PLWH aged ≥19 years from January 2016-September 2018. Participants completed a survey and consented to link their data with the BC Vital Statistics Agency, where deaths were recorded.

Methods: We conducted bivariate analyses to compare characteristics between participants who died with those alive as of September 2021. We used multivariable Cox proportional hazards models to examine factors associated with mortality.

Results: As of September 2021, 71 (11.0%) of 644 participants died. The most common specified cause of death was due to overdose (n = 14, 19.7%). A higher proportion of individuals who died had been incarcerated (52.1% vs. 33.3%; p = 0.002), reported recent homelessness (28.2% vs. 12.6%; p < 0.001) and recent injection drug use (32.4% vs. 19.0%; p = 0.009), compared to those alive at the end of follow-up. Age ≥60 (adjusted hazard ratio [aHR] 3.80, 95% CI 1.55-9.34), and experiencing homelessness in the last 12 months prior to enrolment (aHR 2.01, 95% CI 1.18-3.61) were associated with an increased hazard of death, while identifying as gay or lesbian (aHR 0.42, 95% CI 0.23-0.77), and having greater social support (aHR 0.88 per 10-unit score increase, 95% CI 0.81-0.96) were protective.

Conclusions: Over six years of follow-up, more than 10% of our cohort died, with overdose being the most commonly reported cause of death. PLWH with higher social support however had a lower risk of death in BC.