HIV Mortality Trends Among Older Adults in the United States, 1999-2020

Amatul Marium, Department of Population H, Hofstra University, 106 Hofstra Dome, Hempstead, NY 11549, United States. Electronic address: amarium1@pride.hofstra.edu.
Ayobami S. Ogunsola, Department of Epidemiology and Biostatistics, Texas AandM University, 212 Adriance Lab Rd., College Station, TX 77843-1266, United States. Electronic address: ayobamisam@tamu.edu.
Udeh C. Mercy, Department of Epidemiology and Biostatistics, Texas AandM University, 212 Adriance Lab Rd., College Station, TX 77843-1266, United States. Electronic address: mercyudehc@tamu.edu.
Ifedioranma Anikpo, Department of Public Health Sciences, University of Miami Miller School of Medicine, FL, United States. Electronic address: ioa11@miami.edu.
Maryam A. Sa'id, Bayero University/Aminu Kano Teaching Hospital, Kano State, Nigeria.
Rukayyah M. Karaye, Bayero University/Aminu Kano Teaching Hospital, Kano State, Nigeria.
Aishatu Yusuf, Department of Epidemiology and Biostatistics, Texas AandM University, TX, United States. Electronic address: yusufis6@tamu.edu.
Eniola A. Olatunji, Department of Health Policy and Management, Texas AandM University, 212 Adriance Lab Rd., College Station, TX 77843-1266, United States. Electronic address: eo00960@tamu.edu.
Ismaeel Yunusa, Clinical Pharmacy and Outcomes Sciences, University of South Carolina, 715 Sumter Street - CLS 311 L, Columbia, SC 29208, United States. Electronic address: iyunusa@mailbox.sc.edu.
Ibraheem M. Karaye, Department of Population Health, Hofstra University, 106 Hofstra Dome, Hempstead, NY 11549, United States. Electronic address: ibraheem.m.karaye@hofstra.edu.

Abstract

BACKGROUND: Despite the progress made in managing HIV, the mortality trends among older adults in the US remains understudied. The lack of evidence in this demographic hampers the ability to implement evidence-based interventions. Our aim is to analyze the trends in HIV-related mortality among US citizens aged 65 years and above by demographic characteristics such as age, gender, race/ethnicity, and census region. METHODS: We abstracted national mortality data from the underlying cause of death files in the CDC WONDER database. The ICD-10 Codes- B20-B24 were used to identify HIV deaths among US older adults from 1999 to 2020. Trends in age-adjusted mortality rate (AAMR) were assessed using a five-year simple moving average and Joinpoint analysis. Results were expressed as annual percentage changes (APC), average annual percentage changes, and 95% confidence intervals (CI). RESULTS: Between 1999 and 2020, a total of 15,694 older adults died from HIV in the US (AAMR= 1.7 per 100,000; 95% CI: 1.6 - 1.7). Overall mortality trends increased at an annual rate of 1.5% (95% CI: 1.2, 1.8) from 1999 through 2020. The trends increased among Non-Hispanic Whites, stabilized among Non-Hispanic Blacks, and decreased among Hispanics from 1999 to 2020. Further, the trends increased consistently across categories of age (65 to 74 years; 75 to 84 years), sex, and census region. CONCLUSIONS: HIV mortality among older adults in the US has risen overall from 1999 to 2020, but with varying trends by race and ethnicity. This highlights the need for enhanced public health surveillance to better understand the scope of HIV mortality among older adults and identify high-risk demographic and regional subgroups for targeted interventions. Improving timely diagnosis, managing comorbidities, and stigma surrounding HIV among older adults are crucial to reducing HIV mortality in this population.