Effects of Health Insurance Interruption on Loss of Hypertension Control in Women With and Women Without HIV

Right Censoring and Mortality in the Multicenter AIDS Cohort Study and Women's Interagency HIV Study

BACKGROUND

Epidemiologists frequently employ right censoring to handle missing outcome, covariate, or exposure data incurred when participants have large gaps between study visits or stop attending study visits entirely. But, if participants who are censored are more or less likely to experience outcomes of interest than those not censored, such censoring could introduce bias in estimated measures.

METHODS

We examined how censoring after two consecutive missed visits may affect mortality results from the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). MACS and WIHS provide linkages to vital statistics registries, such that mortality data were available for all participants, regardless of whether they attended study visits.

RESULTS

In a gold standard analysis that did not censor after two consecutive missed visits, 10-year mortality was 23% (95% CI: 22, 24) in MACS and 21% (95% CI: 20, 23) in WIHS. Estimated mortality was modestly reduced by 0%-5% across subgroups when censoring at missed visits. Applying inverse probability of censoring weights partially removed this attenuation.

CONCLUSIONS

While mortality was slightly elevated after two consecutive missed visits in MACS and WIHS, censoring at two consecutive missed visits did not substantially alter estimated mortality, particularly after applying inverse probability of censoring weights.

Hypertension and one-year risk of all-cause mortality among women with treated HIV in the United States

OBJECTIVE

Hypertension is a critical cause of cardiovascular disease, and women with HIV have a higher prevalence of hypertension than women without HIV. The relationship between hypertension and mortality has not been well characterized in women with treated HIV. Here, we estimate the effect of hypertension on 1-year risk of all-cause mortality among women with HIV on antiretroviral therapy (ART) in the United States.

DESIGN

An analysis of multicenter, observational cohort data from the Women's Interagency HIV Study (WIHS) collected between 1995 and 2019.

METHODS

We included women with HIV who reported ever using ART. We used parametric g-computation to estimate the effect of hypertension (SBP ≥140  mmHg, DBP ≥90 mmHg, or use of hypertensive medication) on all-cause mortality within 1 year of a WIHS visit.

RESULTS

Among 2929 unique women, we included 57 034 visits with a median age of 45 (interquartile range: 39, 52) years. Women had hypertension at 34.5% of visits, and 641 deaths occurred within 1 year of a study visit. Comparing women at visits with hypertension to women at visits without hypertension, the standardized 1-year risk ratio for mortality was 1.16 [95% confidence interval (95% CI): 1.01-1.33]. The risk ratios were higher in Hispanic (risk ratio: 1.23, 95% CI: 0.86-1.77) and non-Hispanic black women (risk ratio: 1.19, 95% CI: 1.04-1.37) and lower in non-Hispanic white women (risk ratio: 0.93, 95% CI: 0.58-1.48).

CONCLUSION

Among women with treated HIV, those with hypertension, compared with those without, had an increased 1-year risk of all-cause mortality.

Racial, ethnic, and gender disparities in hospitalizations among persons with HIV in the United States and Canada, 2005-2015

OBJECTIVE

To examine recent trends and differences in all-cause and cause-specific hospitalization rates by race, ethnicity, and gender among persons with HIV (PWH) in the United States and Canada.

DESIGN

HIV clinical cohort consortium.

METHODS

We followed PWH at least 18 years old in care 2005-2015 in six clinical cohorts. We used modified Clinical Classifications Software to categorize hospital discharge diagnoses. Incidence rate ratios (IRR) were estimated using Poisson regression with robust variances to compare racial and ethnic groups, stratified by gender, adjusted for cohort, calendar year, injection drug use history, and annually updated age, CD4+, and HIV viral load.

RESULTS

Among 27 085 patients (122 566 person-years), 80% were cisgender men, 1% transgender, 43% White, 33% Black, 17% Hispanic of any race, and 1% Indigenous. Unadjusted all-cause hospitalization rates were higher for Black [IRR 1.46, 95% confidence interval (CI) 1.32-1.61] and Indigenous (1.99, 1.44-2.74) versus White cisgender men, and for Indigenous versus White cisgender women (2.55, 1.68-3.89). Unadjusted AIDS-related hospitalization rates were also higher for Black, Hispanic, and Indigenous versus White cisgender men (all P < 0.05). Transgender patients had 1.50 times (1.05-2.14) and cisgender women 1.37 times (1.26-1.48) the unadjusted hospitalization rate of cisgender men. In adjusted analyses, among both cisgender men and women, Black patients had higher rates of cardiovascular and renal/genitourinary hospitalizations compared to Whites (all P < 0.05).

CONCLUSION

Black, Hispanic, Indigenous, women, and transgender PWH in the United States and Canada experienced substantially higher hospitalization rates than White patients and cisgender men, respectively. Disparities likely have several causes, including differences in virologic suppression and chronic conditions such as diabetes and renal disease.