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Racial Disparities in HIV-Associated Mortality

In a review of national death certificate data, young black women had a much higher rate of HIV-associated mortality than young white women.

The prevalence of HIV among young women and infants is higher in blacks than in other racial/ethnic groups in the U.S. To determine whether such disparities also exist in HIV-related mortality, investigators reviewed U.S. death certificate data for young women (age range, 14–44) and infants who died between 1990 and 2001. Cause of death was determined from ICD-9 and ICD-10 codes.

During the study period, 43,153 young women and 745 infants reportedly died of HIV-associated causes. The deaths were disproportionately distributed across racial/ethnic groups, with 60% to 70% occurring among blacks. The HIV-associated mortality rate was 13.5 times higher in black women than in white women and 16.3 times higher in black infants than in white infants. The corresponding rate ratios for Hispanics versus whites were 3.4 in women and 2.4 in infants. Although mortality rates decreased between 1995 and 2001 in all racial/ethnic groups, the decline was not as dramatic in young black women (54%) as it was in young white (70%), Hispanic (75%), and Asian women (79%).

Comment: This report is limited by the use of death certificate ICD-9 and -10 codes and the lack of information on access to care, socioeconomic status, and treatment history. However, it does highlight the problem of racial disparities in HIV-associated mortality rates, particularly among young black women. Although potent combination antiretroviral therapy has led to declines in mortality for all racial/ethnic groups, the benefits have not been as great in young black women. In addition, HIV incidence remains higher among black women than white women. Further work is needed to determine the reasons for these disparities and to devise targeted interventions that curb the progression of the HIV epidemic in this high-risk group.

— G. Sonia Nagy, MD

Published in Journal Watch HIV/AIDS Clinical Care August 10, 2005

Citation(s):

Redelings MD et al. High incidence of HIV-associated mortality among black and Hispanic infants and women of childbearing age in the United States 1990–2001. J Acquir Immune Defic Syndr 2005 Aug 1; 39:496-8.