Abstract
BackgroundMultiple cause-of-death (MCOD) data allow analyzing the contribution to mortality of conditions reported on the death certificate that are not selected as the underlying cause of death. Using MCOD data, this study aimed to fully describe the cause-specific mortality of people with AIDS (PWA) compared to people without AIDS.MethodsWe conducted a nationwide investigation based on death certificates of 2,515 Italian PWA and 123,224 people without AIDS who had died between 2006 and 2010. The conditions most frequently associated with PWA mortality, compared to people without AIDS, were identified using an age-standardized proportion ratio (ASPR) calculated as the ratio between the age-standardized proportion of a specific cause among PWA and the same proportion among people without AIDS.ResultsThe most frequently reported conditions at death among PWA were infectious/parasitic diseases (52%), digestive (36%), respiratory (33%), and circulatory (32%) system diseases, and neoplasms (29%). All AIDS-defining conditions resulted highly associated (ASPR significantly greater than unity) with PWA deaths. Significant associations also emerged for leishmaniasis (ASPR = 188.0), encephalitis/myelitis/encephalomyelitis (ASPR = 14.3), dementia (ASPR = 13.1), chronic viral hepatitis (ASPR = 13.1), liver fibrosis/cirrhosis (ASPR = 4.4), pneumonia (ASPR = 4.4), anal (ASPR = 12.1) and liver (ASPR = 1.9) cancers, and Hodgkin’s disease (ASPR = 3.1).ConclusionsStudy findings identified the contribution of several non-AIDS-defining conditions on PWA mortality, emphasizing the need of preventive public health interventions targeting this population.
Highlights
Multiple cause-of-death (MCOD) data allow analyzing the contribution to mortality of conditions reported on the death certificate that are not selected as the underlying cause of death
The analysis of proportion of deaths by underlying cause of death (UC) (Fig. 1a) provided evidence that AIDS deaths were mainly attributable to infectious diseases (68% to AIDS, 2% to other infectious diseases), while low proportions of deaths were due to neoplasms (10%) and diseases of the circulatory system (4%)
The values of the proportion for the specific ICD-10 categories do not sum up to the totals by ICD-10 chapter because 1) only causes of death with a statistically significant age-standardized proportion ratio (ASPR) and with at least 10 cases among AIDS deaths are shown and 2) each death certificate could report more than one cause within the same ICD-10 chapter bOnly females neoplasms, instead, the analysis showed a highest frequency among non-AIDS/HIV deaths (ASPR = 0.6; 95% confidence intervals (CI): 0.6–0.7), as for two major cancer sites, i.e. lung (ASPR = 0.4; 95% CI: 0.3–0.5) and pancreas (ASPR = 0.2; 95% CI: 0.1–0.4)
Summary
Multiple cause-of-death (MCOD) data allow analyzing the contribution to mortality of conditions reported on the death certificate that are not selected as the underlying cause of death. In Italy, about 4,000 new HIV diagnoses and approximately 800 AIDS cases are reported yearly to the National HIV and AIDS surveillance systems, with a steady trend observed in the last decade. The distribution of new AIDS cases by transmission mode has changed over time, with a decreasing proportion of injecting drug users (31.2% in 2005 and 11.3% in 2015) and an increasing proportion of cases acquired through sexual contact (61.3% in 2005 and 79.8% in 2015) [1]. The majority were males (70.1%), Italians (84.4%), and aged between 25 and 49 years (63.4%); the probable route of transmission was heterosexual contact in 37.5% of cases, injecting drug use in 28.1%, and male-to-male contact in 27.9%; 87.6% underwent highly active antiretroviral therapy (HAART) [3]. A growing proportion of Grande et al Population Health Metrics (2017) 15:19 deaths due to non-HIV/AIDS-related causes [5,6,7,8] has emerged over time
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