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Yearly suicide rate in white men with HIV
usually far exceeds rate in US population
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Conference on Retroviruses and Opportunistic Infections (CROI), March 4-7, 2019, Seattle
Mark Mascolini
From 2000 through 2015, suicide rates in white men with HIV exceeded rates among white men in the general US population--and often far exceeded general-population rates [1]. In contrast, suicide rates among black men with HIV hovered around rates in the general population of black men in most years. This US/Canadian analysis of 81,014 people with HIV found that white men who did not inject drugs had a 6-fold higher suicide rate than black men with HIV who did not inject drugs.
Suicide rates are climbing in the US general population, especially among white men and people who use drugs [2]. Researchers working with NA-ACCORD, a North American HIV cohort collaboration, conducted this study to see whether those trends hold true in people with HIV. The study focused on 81,014 HIV-positive cohort members 20 to 79 years old, including 59,919 men, 54% of them white and 46% black. In a subset of 58,961 black or white men, 26% had a drug injection history and 74% did not. The study period ran from January 2000 through December 2015. Researchers recorded suicides noted on death certificates or in electronic medical records. They used Poisson regression models to estimate adjusted incidence rate ratios (aIRR) for suicide.
From 2000 through 2015, suicide rates in white men with HIV exceeded those in general population white men in all but 1 year, in which rates were similar with and without HIV. For all men in the United States, suicide incidence reached 22.4 per 100,000 men in 2017 [2]. Among HIV-positive white men in NA-ACCORD, suicide incidence peaked around 100 per 100,000 men in 2006-2010 then fell over the next 4 years but rebounded to about 80 per 100,000 white men in 2015.
Among black men in the general population, suicide incidence remained consistently lower than in white men across the study period. Black men with HIV had suicide rates exceeding those in the general black male population through 2006. Then suicides among black men with HIV tracked closely with those in the general black male population until 2012-2015, when the rate in black men with HIV fell below the general-population rate.
Among white men who do not inject drugs, suicide incidence lay below 100 per 100,000 men across the study period. But among white men who inject drugs the suicide rate climbed above 100 per 100,000 men in 2004-2010 and again in 2013 and 2015, when the rate reached about 250 per 100,000 white men.
Compared with black HIV-positive men who do not inject drugs, black HIV-positive men who do inject drugs have more than a 2-fold higher suicide rate (aIRR 2.21, 95% confidence interval [CI] 1.03 to 4.73), white HIV-positive men who do not inject drugs have almost a 6-fold higher suicide rate (aIRR 5.92, 95% CI 3.17 to 11.03), and white HIV-positive men who do inject drugs have a 10-fold higher suicide rate (aIRR 9.98, 95% CI 5.13 to 19.40).
In a sample of 7701 women with HIV, the 2000-2015 suicide rate measured 4.17 per 100,000 women (95% CI 0.51 to 15.07). That rate is lower than the 2017 general-population suicide rate of 6.1 per 100,000 in women [2].
The researchers concluded that men with HIV, especially white men and drug injectors, need targeted suicide prevention efforts.
References
1. Althoff KN, Nestadt PS, Lee JS, et al. Suicide rates among US adults living with HIV, 2000-2015. Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2019. Seattle. Abstract 893.
2. Centers for Disease Control and Prevention. Suicide Mortality in the United States, 1999-2017. NCHS Data Brief No. 330, November 2018. https://www.cdc.gov/nchs/products/databriefs/db330.htm
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