1. Increased mortality among Indigenous persons in a multisite cohort of people living with HIV in Canada
- Author
-
Anita Rachlis, Mona Loutfy, Chris Tsoukas, Jaime Younger, Ann N. Burchell, Art Zoccole, Randy Jackson, Anita C Benoit, Tony Nobis, Mark Hull, Earl Nowgesic, Denise Jaworsky, Curtis Cooper, Janet Raboud, Nima Machouf, Renée Masching, Julio S. G. Montaner, Robert S. Hogg, Kerrigan Beaver, Wanda Whitebird, Doe O'Brien-Teengs, Marina B. Klein, Elizabeth Benson, and Sean B. Rourke
- Subjects
Gerontology ,Adult ,Male ,Canada ,Anti-HIV Agents ,Population ,HIV Infections ,Indigenous ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Cause of Death ,Medicine ,Humans ,030212 general & internal medicine ,Mortality ,education ,education.field_of_study ,030505 public health ,business.industry ,Proportional hazards model ,Mortality rate ,Hazard ratio ,Public Health, Environmental and Occupational Health ,General Medicine ,Health Status Disparities ,Middle Aged ,Inuit ,Cohort ,Indians, North American ,Drug Therapy, Combination ,Female ,Quantitative Research ,0305 other medical science ,business ,Viral load ,Cohort study ,Demography - Abstract
OBJECTIVE: Compare all-cause mortality between Indigenous participants and participants of other ethnicities living with HIV initiating combination antiretroviral therapy (cART) in an interprovincial multi-site cohort. METHODS: The Canadian Observational Cohort is a collaboration of 8 cohorts of treatment-naive persons with HIV initiating cART after January 1, 2000. Participants were followed from the cART initiation date until death or last viral load (VL) test date on or before December 31, 2012. Cox proportional hazard models were used to estimate the effect of ethnicity on time until death after adjusting for age, gender, injection drug use, being a man who has sex with men, hepatitis C, province of origin, baseline VL and CD4 count, year of cART initiation and class of antiretroviral medication. RESULTS: The study sample consisted of 7080 participants (497 Indigenous, 2471 Caucasian, 787 African/Caribbean/Black (ACB), 629 other, and 2696 unknown ethnicity). Most Indigenous persons were from British Columbia (BC) (83%), with smaller numbers from Ontario (13%) and Quebec (4%). During the study period, 714 (10%) participants died. The five-year survival probability was lower for Indigenous persons (0.77) than for Caucasian (0.94), ACB (0.98), other ethnicities (0.96) and unknown ethnicities (0.85) ( p < 0.0001). In an adjusted proportional hazard model for which missing data were imputed, Indigenous persons were more likely to die than Caucasian participants (hazard ratio = 2.69, p < 0.0001). CONCLUSION: The mortality rate for Indigenous persons was higher than for other ethnicities and is largely reflective of the BC population. Addressing treatment challenges and identifying HIV- and non-HIV-related causes for mortality among Indigenous persons is required to optimize their clinical management.
- Published
- 2016