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Projected Aging Among People With HIV in the US
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In NYS it's projected that by 2040 28% will be over 65 and median age will be 67.
In this decision analytic model, we used a calibrated model of HIV transmission to project the future age distribution of PWDH in 24 US states. By 2040, we projected that the median age of adult PWDH across these states will increase from 51 to 61 years, and nearly half of adult PWDH will be over the age of 65 years, while the median age in the general adult population will remain near 44 years during the same period.
In general, states with large, urban epidemics among populations of PWDH with a higher median age in 2025-such as California, New York, Florida, and Maryland-were projected to have larger increases in median age from 2025 to 2040 (Figure 3).
As PWDH age across the country, federal and local HIV programming will need to adapt to support their evolving needs, especially in light of growing workforce shortages in HIV care.19
This will translate to a higher demand for Medicare and other federally funded programs to provide comprehensive care and support services-for example, among the Medicare-eligible population (aged at least 65 years), the number of PWDH is projected to grow from 3.0 per thousand in 2025 to 5.4 per thousand in 2040. Federal programs can support this change by providing funding for integrated HIV and primary care, developing national guidelines for age-appropriate HIV care (including comorbidity management), supporting workforce training in geriatric HIV care, expanding coverage for age-related conditions, and investing in future research and programs that promote healthy aging and reduce long-term health care costs.
At a local level, the percentage increase in number of aging PWDH can vary substantially, with some states expected to experience an increase of more than 30% in the coming decade. Meeting this demand will require a rapid shift in the structure and scope of local HIV programs. Of note, local programs can integrate HIV and primary care to ensure HIV clinicians are prepared to manage age-associated comorbidities among patients, including cardiovascular and metabolic diseases. They should also support mental and cognitive health by offering counseling, cognitive screening, and services tailored to an aging population. Further social and community services-such as transportation, housing, and peer support-can enhance quality of life, reduce isolation, and promote healthy aging among older PWDH.
Key Points
Question How will the age distribution of people living with diagnosed HIV change between 2025 and 2040?
Findings In this decision analytic model using a calibrated model of HIV transmission in 24 US states, projections indicated that by 2040, the median age of adult people with diagnosed HIV (PWDH) in those 24 states will increase from 51 to 61 years, and nearly half of adult PWDH will be older than 65 years. Substantial differences in projected age distribution by state were found.
Meaning These findings suggest that in the coming years, federal and local health care planning will need to adapt to changing state-level demographic patterns among PWDH.
Abstract
Importance As the population living with HIV in the US ages, state-level projections of the aging dynamics among people with diagnosed HIV (PWDH) will be needed to inform local planning and intervention efforts.
Objective To explore how aging dynamics of PWDH in the US are expected to differ at the state level between 2025 and 2040.
Design, Setting, and Participants This decision analytic model used a calibrated model of HIV transmission to project epidemic trajectories from 2025 to 2040 in 24 US states representing 86% of PWDH in the US.
Main Outcomes and Measures Change in median age of PWDH, among those older than 13 years, was estimated from 2025 to 2040 for each state.
Results Among the 24 states analyzed, projections showed that by 2040, the median age of adult PWDH will increase from a mean of 51 (95% credible interval [CrI], 51-52) years to 61 (95% CrI, 59-63) years, and 46% (95% CrI, 43%-48%) of adult PWDH will be older than 65 years. Substantial heterogeneities were found in age distributions by state. More populous and urban states with higher median ages of PWDH in 2025 were projected to experience even further aging of the population with diagnosed HIV in the coming 15 years. By contrast, more rural and less populous states had younger populations of PWDH that were not projected to age substantially over time.
Conclusions and Relevance This decision analytic model found that although the overall population of PWDH in the US is projected to age substantially, these effects will unfold differently across states. In the coming years, health care systems will need to plan to adapt to changing state-level demographic patterns among PWDH.
States whose populations of PWDH were larger, more urban, and older in 2025 had the greatest projected increases in median age. For example, in California, the median age of PWDH increased by a mean of 14 (95% CrI, 12-15) years, from 53 (95% CrI, 52-55) years in 2025 to 67 (95% CrI, 64-69) years in 2040; Maryland, New York, and Florida had similar profiles. Meanwhile, states with small, rural, and younger populations of PWDH were projected to see decreasing median ages, with generally more uncertainty in their model projections. Arkansas' median age among adult PWDH was projected t
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2853783
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