Abstract
Background Increasing alcohol use is associated with increased risk of mortality among patients living with HIV (PLWH). This association varies by race/ethnicity among general outpatients, but racial/ethnic variation has not been investigated among PLWH, among whom racial/ethnic minorities are disproportionately represented.MethodsVA electronic health record data from the Veterans Aging Cohort Study (2008–2012) were used to describe and compare mortality rates across race/ethnicity and levels of alcohol use defined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. Within each racial/ethnic group, Cox proportional hazards models, adjusted for age, disease severity, and comorbidities, compared mortality risk for moderate-risk (AUDIT-C = 4–7) and high-risk (AUDIT-C ≥ 8) relative to lower-risk (AUDIT-C = 1–3) alcohol use.ResultsMean follow-up time among black (n = 8518), Hispanic (n = 1353), and white (n = 7368) male PLWH with documented AUDIT-C screening (n = 17,239) was 4.3 years. Black PLWH had the highest mortality rate among patients reporting lower-risk alcohol use (2.9/100 person-years) relative to Hispanic and white PLWH (1.8 and 2.3, respectively) (p value for overall comparison = 0.011). Mortality risk was increased for patients reporting high-risk relative to lower-risk alcohol use in all racial/ethnic groups [black adjusted hazard ratio (AHR) = 1.36, 95% confidence interval (CI) 1.12–1.66; Hispanic AHR = 2.18, 95% CI 1.30–3.64; and white AHR = 2.04, 95% CI 1.61–2.58]. For only white PLWH, mortality risk was increased for patients reporting moderate-relative to lower-risk alcohol use (black AHR = 1.09, 95% CI 0.93–1.27; Hispanic AHR = 1.36, 95% CI 0.89–2.09; white AHR = 1.51, 95% CI 1.28–1.77).ConclusionAmong all PLWH, mortality risk was increased among patients reporting high-risk alcohol use across all racial/ethnic groups, but mortality risk was only increased among patients reporting moderate-risk relative to lower-risk alcohol use among white PLWH, and black patients appeared to have higher mortality risk relative to white patients at lower-risk levels of alcohol use. Findings of the present study further underscore the need to address unhealthy alcohol use among PLWH, and future research is needed to understand mechanisms underlying observed differences.
Highlights
Increasing alcohol use is associated with increased risk of mortality among patients living with human immunodeficiency virus (HIV) (PLWH)
Alcohol use adversely influences health among patients living with HIV (PLWH) and is associated with lower receipt and poorer outcomes of HIV treatment, and with mortality among PLWH [1,2,3,4,5]
Because risk factors and influences of health behaviors are likely to vary among racial/ethnic groups depending on their lived experiences, experts have called for studies to examine alcohol-related risk among vulnerable sub-populations of PLWH [5]
Summary
Increasing alcohol use is associated with increased risk of mortality among patients living with HIV (PLWH). Racial/ethnic minority PLWH experience increased HIV stigma [9], socioeconomic disadvantage and increased persecution [10], and decreased access to care [3] that may make consequences of alcohol use worse for racial/ethnic minority [10] relative to white PLWH [11,12,13,14,15]. Previous studies in non-HIV-specific populations demonstrate that racial/ethnic minorities have worse consequences at similar levels of alcohol use [16] and higher risk of mortality at lower levels of alcohol use than whites [17]. We evaluated whether the association between level of alcohol use and mortality differs across racial/ethnic groups in a national sample of PLWH
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