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Sex-specific Patterns in HIV-associated
Cardiovascular Mortality in New York City
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Reported by Jules Levin
CROI 2019 March 4-7 Seattle
David B. Hanna1, Chitra Ramaswamy2, Robert C. Kaplan1,3, Jorge R. Kizer4,5, Demetre Daskalakis2, Kathryn Anastos1, Sarah L. Braunstein2
1Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 2New York City Department of Health and Mental Hygiene, Long Island City, NY,
3Fred Hutchinson Cancer Center, Seattle, WA, 4San Francisco Veterans Affairs Health Care System, San Francisco, CA, 5University of California, San Francisco, CA
CROI 2015: CARDIOVASCULAR DISEASE MORTALITY AMONG HIV-INFECTED PERSONS, NEW YORK CITY, 2001-2012
https://www1.nyc.gov/assets/doh/downloads/pdf/dires/hiv-aids-in-women.pdf
We previously identified more pronounced associations between HIV status and cardiovascular disease mortality in women than men in New York City. However, because socioeconomic status may confound this relationship and New York City contains both some of the highest and lowest income counties in the nation, we re-analyzed this data restricted to the Bronx, which is both a high HIV prevalence and lower income borough/county.
We included all residents age 13+ reported with HIV to the population-based New York City HIV Surveillance Registry and living between 2007 and 2012. Surveillance data were linked with the city Vital Statistics Registry and National Death Index. Residents without HIV living in each borough, including the Bronx, were enumerated using modified US intercensal estimates after subtracting the surveillance-based counts of those with HIV. We examined sex-specific rates of death due to major cardiovascular diseases (ICD-10 codes I00-I78). Using log-linear models, we determined the association of HIV serostatus with cardiovascular disease mortality rates by sex within each borough, and compared this to the relationship across all New York City residents.
There were 1,673 deaths attributed to cardiovascular disease as the underlying cause among HIV+ New Yorkers between 2007 and 2012, with 376 of these occurring among Bronx residents. In the Bronx, the age-adjusted cardiovascular disease mortality rate was 3.33/1,000 person-years (95% confidence interval [CI] 2.45-4.21) among HIV+ men and 2.47/1,000 (95% CI 1.42-3.51) among HIV+ women. In analyses of the entire city, the relative rate of cardiovascular disease mortality attributed to HIV serostatus was almost twice as high in women (rate ratio [RR] 2.18, 95% CI 1.96-2.42) than men (RR 1.17, 95% CI 1.08-1.26, P for interaction After accounting for socioeconomic status through restriction, we found that sex differences in the association of HIV with cardiovascular disease mortality were attenuated. More work is needed to better characterize how socioeconomic and biological factors related to sex may affect cardiovascular disease in people living with HIV.
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