Academic journal article Canadian Journal of Public Health

Trends in HIV/AIDS Mortality in Canada, 1987-1998

Academic journal article Canadian Journal of Public Health

Trends in HIV/AIDS Mortality in Canada, 1987-1998

Article excerpt

ABSTRACT

Objective: To monitor Canadian HIV/AIDS mortality following the introduction of antiretroviral therapies in 1996, and to compare this with the US experience.

Methods: Deaths were extracted by underlying cause of death, age, sex, marital status and place of residence at time of death. Age-specific leading causes of death, potential years of life lost before age 65, and rates are presented.

Results: HIV deaths peaked in 1995 at 1,764, representing 1% of all deaths, 15% of male deaths aged 25-44, and the second leading cause of death for males age 25-44, trailing suicides. From 1995 to 1997, HIV deaths dropped by 66% for males and 43% for females. Rates for Toronto, Vancouver and Montreal were 6 times higher than in rural areas, and 2.5 times higher than in other Census Metropolitan Areas.

Conclusions: As of 1998, HIV still was a leading cause of premature mortality. The trend in Canadian HIV mortality was similar to that in the US, though US rates remain double the Canadian rates. The drop in HIV deaths may not be sustained in the long term, as antiretroviral therapy is not a cure and the number of people living with HIV is increasing.

The impact of HIV infection on mortality has reached unprecedented rates for an infective organism in recent times. Improved antiretroviral therapies, available since 1996, have been credited with recent declines in HIV mortality rates.1-5 This report updates studies of HIV mortality in Canada6-8 that cover the period prior to the availability of highly affective antiretroviral therapies (HAART) and supplements national HIV and AIDS surveillance reports.9 The effectiveness of HAART in reducing HIV mortality in Canada is compared with the experience in the United States where deaths due to HIV infection increased an average of 16% per year, reaching a peak in 1995 at 2% of all deaths, and despite significant declines in mortality, HIV still accounted for 7% of all deaths in 25-44 year olds in 1999 in the United States.10-12

At the peak in 1995, HIV ranked 8th as a leading cause of death in the US, and 4th as a leading cause of potential years of life lost before age 65 (PYLL65).12 This report includes a similar summary of Canadian leading causes of death. In contrast, the standard Statistics Canada report13 on leading causes of death ranks disease chapters, and HIV was not specifically included in the ranking.

HIV deaths occurred at a relatively young age and were concentrated in specific geographic locations;6,14 for example, most HIV deaths in British Columbia occurred among residents of Vancouver or Victoria.7 Changes in geographic pattern of HIV mortality are reviewed.

METHODS

Records of registrations of deaths occurring in Canada, maintained by the provincial and territorial registrars of the Offices of Vital Statistics, were coded by the provinces or Statistics Canada using the ninth revision of the International Classification of Disease (ICD-9). HIV (Human Immunodeficiency Virus) deaths were coded to ICD-9 042-044 since 1987. Mortality rates were calculated from deaths15 and population counts16 provided by Statistics Canada, by age, sex, area of residence and year using Health Canada's ORIUS software.17 US age-specific mortality rates were provided by the National Center for Health Statistics.10,12

Age-standardized mortality rates (ASMRs) were calculated for Canadian and US HIV mortality by directly adjusting the age-specific rates to the 1991 Canadian standard population. The statistical significance of differences in rates among sub-populations were assessed using the standardized mortality rate (SMR); the ratio of the observed number of deaths divided by the expected number of deaths based on the rates of the reference population. Confidence limits were calculated based on Byar's approximation.18

Leading causes of death were obtained by ranking mutually exclusive disease groups. ICD-9 groups causes of death into 16 disease chapters plus a supplementary classification for the coding of external causes of injuries and poisonings. …

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