1996-2020年不列颠哥伦比亚省男性和女性艾滋病毒感染者的预期寿命和死亡率：一项基于人群的队列研究

IF 25.2 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Lancet Public Health Pub Date : 2025-02-06 DOI:10.1016/s2468-2667(24)00304-9

Katherine W Kooij, Wendy Zhang, Jason Trigg, Nance Cunningham, Michael O Budu, Megan E Marziali, Viviane Dias Lima, Kate A Salters, Rolando Barrios, Julio S G Montaner, Robert S Hogg

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引用次数: 0

摘要

艾滋病毒感染者的预期寿命已大大延长。我们使用来自比较结果和服务利用趋势（COAST）研究的数据来检查1996年至2020年间加拿大不列颠哥伦比亚省（BC）艾滋病毒感染者的预期寿命和死亡率的性别差异。方法scoast是一项基于人群的队列研究，包括不列颠哥伦比亚省几乎所有艾滋病毒感染者的临床和行政健康数据。我们计算了20岁、40岁和55岁艾滋病毒感染者的预期寿命，并按性别和日历时期进行了分层。我们使用Cox回归对性别与全因死亡率和特定原因死亡率之间的关系进行建模，并对健康的个人和社会决定因素进行调整。结果：在年龄≥20岁的14272例HIV感染者中，男性11738例（82.2%），女性2534例（17.8%）。从1996-2001年到2012-20年，20岁男性的预期寿命增加了23.54岁（从24.46岁增加到48.00岁），但同期女性的预期寿命仅增加了18.81岁（从22.13岁增加到40.94岁）。同样，40岁和55岁的预期寿命随着时间的推移在所有阶层都有所增加，但女性的预期寿命仍然低于男性。20岁和40岁预期寿命的性别差距随着时间的推移而扩大。女性性别与全因死亡率之间的相关性减弱，但在调整个人和社会健康决定因素后仍具有统计学意义（风险比1.11 [95% CI 1.03 - 1·20]）。尽管在1996年至2020年期间，不列颠哥伦比亚省艾滋病毒感染者的预期寿命有所增加，但女性的预期寿命仍然低于男性，两者之间的差距随着时间的推移而扩大。全因死亡率的性别差异部分可以用已知的社会结构决定因素和免疫状况的差异来解释。应将感染艾滋病毒的妇女视为公共卫生战略的优先事项，以解决对健康产生不利影响的结构性因素。资助加拿大卫生研究院（CIHR）、BC省卫生研究院、CIHR加拿大艾滋病毒试验网络和国家卫生研究院。

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Life expectancy and mortality among males and females with HIV in British Columbia in 1996–2020: a population-based cohort study

Background

Life expectancy of people with HIV has increased considerably. We used data from the Comparative Outcomes And Service Utilization Trends (COAST) study to examine sex differences in life expectancy and mortality between 1996 and 2020 among people with HIV in British Columbia (BC), Canada.

Methods

COAST, a population-based cohort study, includes clinical and administrative health data on virtually all people with HIV in BC. We calculated life expectancy for people with HIV at ages 20, 40, and 55 years stratified by sex and calendar period. We used Cox regression to model associations between sex and all-cause and cause-specific mortality, adjusting for individual and social determinants of health.

Findings

11 738 males (82·2%) and 2534 females (17·8%) of 14 272 people with HIV, aged ≥20 years, were included. Life expectancy at age 20 years for males increased by 23·54 years from 1996–2001 to 2012–20 (from 24·46 years to 48·00 years), but life expectancy for females in that period increased only by 18·81 years (from 22·13 years to 40·94 years). Similarly, life expectancy at ages 40 years and 55 years increased over time in all strata but remained lower among females than males. The sex-gap in life expectancy at ages 20 and 40 years increased over time. The association between female sex and all-cause mortality was attenuated but remained statistically significant after adjusting for individual and social determinants of health (hazard ratio 1·11 [95% CI 1·03–1·20]).

Interpretation

Although life expectancy among people with HIV in BC increased between 1996 and 2020, life expectancy of females remained lower than males with the gap between them increasing over time. Sex differences in all-cause mortality were partially explained by differences in known socio-structural determinants and immune status. Women with HIV should be considered a priority for public health strategies to address structural factors with adverse health impact.

Funding

Canadian Institutes of Health Research (CIHR), Health Research BC, CIHR Canadian HIV Trials Network, and National Institutes of Health.

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来源期刊

Lancet Public Health Medicine-Public Health, Environmental and Occupational Health

CiteScore

55.60

自引率

0.80%

发文量

305

审稿时长

8 weeks

期刊介绍： The Lancet Public Health is committed to tackling the most pressing issues across all aspects of public health. We have a strong commitment to using science to improve health equity and social justice. In line with the values and vision of The Lancet, we take a broad and inclusive approach to public health and are interested in interdisciplinary research. We publish a range of content types that can advance public health policies and outcomes. These include Articles, Review, Comment, and Correspondence. Learn more about the types of papers we publish.