Firearm Homicide and Other Causes of Death in Delinquents: A 16-Year Prospective Study

2017 ◽  
pp. 99-117
Author(s):  
Linda A. Teplin ◽  
Jessica A. Jakubowski ◽  
Karen M. Abram ◽  
Nichole D. Olson ◽  
Marquita L. Stokes ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Causes Of Death ◽  
Significant Risk ◽  
Target Population ◽  
Mortality Rates ◽  
Violent Death ◽  
Delinquent Youth ◽  
Hispanic Males ◽  
Race Ethnicity

BACKGROUND Delinquent youth are at risk for early violent death after release from detention. However, few studies have examined risk factors for mortality. Previous investigations studied only serious offenders (a fraction of the juvenile justice population) and provided little data on females. METHODS The Northwestern Juvenile Project is a prospective longitudinal study of health needs and outcomes of a stratified random sample of 1829 youth (657 females, 1172 males; 524 Hispanic, 1005 African Amer-ican, 296 non-Hispanic white, 4 other race/ethnicity) detained between 1995 and 1998. Data on risk factors were drawn from interviews; death records were obtained up to 16 years after detention. We compared all-cause mortality rates and causes of death with those of the general population. Survival analyses were used to examine risk factors for mortality after youth leave detention. RESULTS Delinquent youth have higher mortality rates than the general population to age 29 years (P < .05), irrespective of gender or race/ ethnicity. Females died at nearly 5 times the general population rate (P < .05); Hispanic males and females died at 5 and 9 times the general population rates, respectively (P < .05). Compared with the general population, significantly more delinquent youth died of homicide and its subcategory, homicide by firearm (P < .05). Among delinquent youth, racial/ethnic minorities were at increased risk of homicide compared with non-Hispanic whites (P < .05). Significant risk factors for external-cause mortality and homicide included drug dealing (up to 9 years later), alcohol use disorder, and gang membership (up to a decade later). CONCLUSIONS Delinquent youth are an identifiable target population to reduce disparities in early violent death.

Clinical factors and mortality rates for non-traumatic upper extremity amputations

2021 ◽  
pp. 175319342110427
Author(s):  
Yong-Zheng Jonathan Ting ◽  
An-Sen Tan ◽  
Chi-Peng Timothy Lai ◽  
Mala Satku
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Significant Risk ◽  
Arterial Disease ◽  
Mortality Rates ◽  
Level Of Evidence ◽  
Peripheral Arterial ◽  
Extremity Amputation

Non-traumatic upper extremity amputations are an increasing concern with the rising prevalence of diabetes mellitus. To ascertain the risk factors and mortality rates for these amputations, the demographic information, amputation history, comorbidities and clinical outcomes of 140 patients who underwent non-traumatic upper extremity amputations between 1 January 2004 and 31 October 2017 were studied. Correlations were assessed using Cochran-Armitage chi-squared tests, odds ratios and multivariate binomial logistic regression as appropriate. Diabetes mellitus, coronary artery disease, end-stage renal failure, peripheral arterial disease and prior lower extremity amputation were significant risk factors for multiple upper extremity amputations. One-year, 2-year and 5-year mortality rates were 12%, 15% and 38%, respectively, following first upper extremity amputation. The risk factors for upper extremity amputations correspond with those for lower extremity amputations, comprising mainly diabetes mellitus and its related comorbidities. The mortality rates for non-traumatic upper extremity amputations highlight their significant burden on patients. Level of evidence: III

scholarly journals MON-585 Racial/Ethnic Contribution and Metabolic Factors of NAFLD/NASH in the US Population: Data from NNANES III

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Theodore C Friedman ◽  
Magda Shaheen ◽  
Dulcie Kermah ◽  
Deyu Pan ◽  
Katrina Schrode ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Liver Enzyme ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Healthy Eating Index ◽  
C Peptide ◽  
The Us ◽  
Race Ethnicity ◽  
Racial Ethnic

Abstract Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver condition. It is manifested by hepatic steatosis (HS) that can progress to non-alcoholic steatohepatitis (NASH), and even liver failure. Interestingly, it is marked by racial/ethnic disparities, with a high prevalence in Hispanics. We aimed to identify the risk factors for these chronic conditions in the US. To this end, we analyzed data from NHANES III (1988-1994) using multiple or multinomial logistic regression considering the design and sample weight. HS was identified by ultrasound. NAFLD was defined as HS in the absence of viral hepatitis or excessive use of alcohol or hepatotoxic drugs. The NAFLD population was further divided into those with NASH (defined by the HAIR score), or with simple NAFLD. The prevalence of HS was 19.8%, 16.6%, and 27.9%; of NAFLD was 17.8%, 14.7%, and 25.5%; and of NASH was 3.2%, 2.5%, and 5.1% in non-Hispanic Whites, non-Hispanic Blacks and Hispanics, respectively. Race/ethnicity was a significant predictor of HS, NAFLD and NASH, with Hispanics having the highest odds for all conditions, and non-Hispanic Blacks having the lowest odds relative to Whites (p<0.05). Other significant risk factors for all three conditions were older age, higher BMI, abnormal levels of C-peptide, and elevated serum glucose and triglycerides (p<0.05). HOMA insulin resistance was associated with HS and NAFLD (p<0.05). While smoking status was not associated with HS (p>0.05), current smokers had lower odds of NAFLD & NASH than non-smokers (p<0.05). Elevation of the liver enzyme aspartate aminotransferase was a significant risk factor of HS, while elevation of the liver enzyme alanine transaminase was a significant risk factor of NAFLD. Elevation in the levels of both liver enzymes was predictive of NASH (p<0.05). Although we included physical activity relative to national recommendation variable and the Healthy Eating Index (a measure of diet quality) in our analyses, neither of these factors was a predictor of any of the liver conditions (p>0.05). Our results showed an independent association between race/ethnicity and HS, NAFLD, and NASH, whereby Hispanics had the highest odds for every condition relative to non-Hispanic Whites. Providers should consider the race/ethnicity of their patients when evaluating the risk for NAFLD and NASH, and also be aware of the other risk factors, such as BMI and levels of C-peptide, glucose, and triglycerides.

Tumour incidence in Fabry disease: A cross-sectional study

2019 ◽  
Vol 3 (2) ◽  
pp. 80-87
Author(s):  
Federica Rossi ◽  
Sara Auricchio ◽  
Agnese Binaggia ◽  
Vincenzo L’imperio ◽  
Fabio Pagni ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Fabry Disease ◽  
Incidence Rate ◽  
Early Stage ◽  
Treatment Success ◽  
Significant Risk ◽  
Cancer Development ◽  
Cancer Prevalence ◽  
Enzyme Replacement

Background: Recently, a possible correlation between altered glycosphingolipid metabolism, that occurs in Fabry disease, and cancer development has been suggested. We analysed both incidence and prevalence of benign and malignant tumours in a Fabry patient cohort and compared them with the Italian general population. The analysis of major risk factors was performed. Methods: A total of 53 Fabry patients, followed by Nephrology Unit of San Gerardo Hospital (Monza, Italy), were retrospectively enrolled. Primary outcome was cancer development during the follow-up period (2007–2017). Cancer prevalence and incidence rate were calculated and compared to those in the Italian general population, acquired from public report on cancer estimates produced by the Cancer Registers’ Italian Association. Fisher’s exact test and multivariate analysis were performed to identify significant risk factors. Results: Nine (17%) patients were diagnosed with malignant neoplasia (stage T1–T3, N0M0). Most of them were female (77.8%) and were 59 ± 9 years old. In the benign tumour group, different lesions, ranging from adenoma to dysplasia, were recorded. Italian cancer prevalence is currently 5.5%, while in our population it was 17%; the incidence rate ratio of the Fabry population compared with the general population was 2.66 (95% confidence interval from 1.33 to 5.32). The risk factor analysis has revealed that older age was a negative factor for cancer onset, while enzyme replacement therapy had a protective role effect against cancer in Fabry patients. Conclusion: Cancer could be an important associated pathology in Fabry patients. Their altered glycosphingolipid metabolism may have an oncogenic role. Further studies are needed to clarify the relationships between Fabry disease and cancer onset. Tumours in Fabry subjects could be diagnosed at an early stage allowing patients to have a concrete chance of treatment success.

Smoking and Malignancy in Schizophrenia

1984 ◽  
Vol 145 (4) ◽  
pp. 429-432 ◽  
Author(s):  
E. Masterson ◽  
B. O'Shea
Keyword(s):  
General Population ◽  
Lower Risk ◽  
Intestinal Tract ◽  
Causes Of Death ◽  
Mortality Rates ◽  
Proportional Mortality ◽  
Schizophrenic Patients ◽  
Smoking Patterns ◽  
Gastro Intestinal Tract ◽  
Risk Of Cancer

SummaryIt has been suggested that schizophrenic patients have a lower risk of cancer than the general population. We therefore investigated the smoking patterns of 100 current chronic schizophrenic in-patients, and the causes of death in 122 recently deceased schizophrenics. We found that schizophrenics are heavy smokers, and that schizophrenics do die from carcinoma of the bronchus. Proportional mortality rates for all malignancies were not significantly lower in schizophrenics than in the general population but there was a significant absence of cancer of the gastro-intestinal tract. Proportional mortality rates for female mammary carcinoma, pneumonia, and suicide were raised, and that for cerebrovascular disease was low. These differences between schizophrenics and the general population warrant further investigation.

scholarly journals Mortality and risk factors of disease in Nepal: Trend and projections from 1990 to 2040

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243055
Author(s):  
Achyut Raj Pandey ◽  
Binaya Chalise ◽  
Niraj Shrestha ◽  
Biwesh Ojha ◽  
Jasmine Maskey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Burden Of Disease ◽  
Causes Of Death ◽  
Mortality Rates ◽  
Metabolic Risk Factors ◽  
Years Of Life Lost ◽  
Ageing Population ◽  
Metabolic Risk ◽  
High Systolic Blood Pressure ◽  
Life Style Changes

Background Between 1990 and 2017, Nepal experienced a shift in the burden of disease from communicable, maternal, neonatal and nutritional (CMNN) diseases to non-communicable diseases (NCDs). With an increasing ageing population and life-style changes including tobacco use, harmful alcohol consumption, unhealthy diets, and insufficient physical activity, the proportion of total deaths from NCDs will continue to increase. An analysis of current diseases pattern and projections of the trends informs planning of health interventions. This analysis aims to project the mortality and risk factor of disease until 2040, based on past trends. Methods This study uses secondary data from the Global Burden of Disease (GBD) Study which analyses historic data from 1990 to 2016 to predict key variables such as, the mortality rates, life expectancy and Years of Life Lost for different causes of death from 2017 to 2040. ‘GBD Foresight Visualization’, a visualisation tool publicly available in the webpage of Institute for Health Metrics and Evaluation was the source of data for this analysis. GBD forecasting uses three-component modelling process: the first component captures variations due to risk factors and interventions, the second takes into consideration the variation due to measures of development quantified as social development index and the third uses an autoregressive integrated moving average model to capture the unexplained component correlated over time. We extracted Nepal specific data from it and reported number of deaths, mortality rates (per 100,000 population) as well as causes of death for the period 1990 to 2040. Results In 1990, CMNN diseases were responsible for approximately two-thirds (63.6%) of total deaths in Nepal. The proportion of the deaths from the CMNN diseases has reduced to 26.8% in 2015 and is estimated to be about a fifth of the 1990 figure (12.47%) in 2040. Conversely, deaths from NCDs reflect an upward trend. NCDs claimed a third of total deaths (29.91%) in the country in 1990, while in 2015, were responsible for about two-thirds of the total deaths (63.31%). In 2040, it is predicted that NCDs will contribute to over two-thirds (78.64%) of total deaths in the country. Less than a tenth (6.49%) of the total deaths in Nepal in 1990 were associated with injuries which increased to 13.04% in 2015 but is projected to decrease to 8.89% in 2040. In 1990, metabolic risk factors including high systolic blood pressure, high total cholesterol, high fasting plasma glucose, high body mass index and impaired kidney functions collectively contributed to a tenth of the total deaths (10.38%) in Nepal, whereas, in 2040 more than a third (37.31%) of the total deaths in the country could be attributed to it. Conclusion A reverse of the situation in 1990, NCDs are predicted to be the leading cause of deaths and metabolic risk factors are predicted to contribute to the highest proportion of deaths in 2040. NCDs could demand a major share of resources within the health sector requiring extensive multi-sectoral prevention measures, re-allocation of resources and re-organisation of the health system to cater for long-term care.

Disparate Rates of Cesarean Delivery in Term Nulliparous Women with Hypertensive Disorders of Pregnancy

2019 ◽  
Vol 36 (10) ◽  
pp. 997-1001 ◽  
Author(s):  
Christina A. Penfield ◽  
Michael P. Nageotte ◽  
Deborah A. Wing
Keyword(s):  
Risk Factors ◽  
Cesarean Delivery ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Target Population ◽  
Vital Statistics ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Important Target ◽  
Nulliparous Women

Objective To evaluate the prevalence of cesarean delivery in women with hypertensive disorders of pregnancy (HDP), and explore whether maternal, sociodemographic, or obstetric comorbidities contribute to cesarean delivery rates. Study Design This is a retrospective cohort study of nulliparous, term, singleton, vertex women using the 2013 U.S. National Vital Statistics Report. We compared prevalence of risk factors for cesarean delivery between women with and without HDP, and then calculated probabilities of cesarean delivery after controlling for these risk factors. Results In this cohort of 1,439,977 women, the unadjusted probability of cesarean delivery in women with HDP was 39.5 versus 26.8% in those without the diagnosis (p < 0.01). Hypertensive women had more risk factors for cesarean delivery, most notably morbid obesity (9.0 vs. 3.1%, p < 0.01), diabetes (9.9 vs. 4.4%, p < 0.01), and induction of labor (59.2 vs. 26.9%, p < 0.01). Despite this, after controlling for these risk factors, hypertensive women remained significantly more likely to undergo cesarean delivery (35.1 vs. 26.4%, p < 0.01). Conclusion Even after controlling for multiple comorbidities, hypertension remained a significant risk factor for cesarean delivery in nulliparous women at term. Hypertensive women may therefore represent an important target population in efforts aimed at reduction of cesarean rates.

P1332VASCULAR ACCESS IN OLDER ADULTS: MOSCOW REGION REGISTER ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Aleksei Zulkarnaev ◽  
Vadim Stepanov ◽  
Andrey Vatazin ◽  
Ewgenii Strugaylo ◽  
Natalia Fominykh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Older Adults ◽  
Blood Flow ◽  
General Population ◽  
Elderly Patients ◽  
Vascular Access ◽  
Significant Risk ◽  
Younger Patients ◽  
Risk Of Death

Abstract Background and Aims For many years we observed aging of HD population: the proportion older adults is increasing. These patients have extremely low kidney transplantation rate, so vascular access is not a temporary option, but an important factor until the end of life. At the same time in older adults life expectancy is lower and the risks of cardiovascular events are much higher than in the general population of HD patients. We analyzed the results of providing elderly patients with vascular access. Method The study included 618 patients (age ≥ 65) from the Moscow region CKD patients register. Results With the current practice, only about 60% of elderly patients begin HD within a year after the AVF creation (taking into account competing events) - fig. 1. The proportion of patients with brachiocephalic AVF was significantly higher than in younger patients: 41,3% vs. 16,4%. It is known that proximal AVF have a much greater tendency to increase the volume blood flow (and therefore – cardiopulmonary recirculation) than distal. Thus, elderly patients begin HD with a more adverse comorbid background. Therefore, elderly patients have an additional risk factor - the onset of HD after 65 years – fig 2. Paradoxically, but according to our data, patients who started HD after 65 years had a worse prognosis than patients who reached 65 while already on HD. At the same time, the onset of HD with CVC with the subsequent successful conversion to AVF was not associated with a significant increase in the risk of death («CVC-AVF» factor). Only if CVC remained the only vascular access («CVC» factor), the risk of death is increase significantly. This is indirect evidence in favor of the fact that in elderly patients, the AVF must be created closer to the expected start of HD. In adjusted model, the significant risk factors also were diabetes, systemic diseases (factor «Other») and comorbidity (CIRS score), but not age. Among patients who started HD with CVC, all patients received functional AVF or died within 11 months – fig. 3. Infections occur with the same frequency (CVC-AVF vs. AVF) and clinical manifestations of central venous insufficiency do not have time to occur during the expected life period in most patients: incidence rate ratio IRR 1.21 [0.91; 1.31] and IRR 1.11 [0.93; 1.19], respectively. Is a conversion of AVF to CVC can improve the outcomes in older adults? In some patients probably - yes. Since many elderly patients initially have heart failure and a reduced cardiac output (CO), the potential for compensating of AVF blood flow (Qa) is significantly less than in younger patients. We found that this leads to the fact that in the elderly, at a lower Qa value, a greater value of cardiopulmonary recirculation is noted. Even with a Qa value of 1.0-1.2 l/min, the Qa/CO value can reach ≈ 25%, which is associated with a significant risk of death. But there is good news: in the older adults some criteria are more informative than in the general population of HD patients: AUC-ROC of ejection fraction (EF), estimated pulmonary artery systolic pressure (ePASP) and Qa/CO – 0.821, 0.804 and 0.846, respectively vs. 0.654, 0.726 and 0.764. The bad news: the decision to convert from a functional AVF to a CVC is a very difficult choice. Specific indications are still not determined. We believe that it is necessary to consider the conversion from AVF to CVC in a case of decompensated heart failure, with EF&lt;30-33% or ePASP&gt;50-55 or Qa/CO&gt;20-25%, if the reduction of Qa does not improve these parameters. In this case, conversion from CVC to AVF may improve the prognosis. Older patients require more careful monitoring than younger patients. Conclusion 1. The start of HD with CVC is not a problem in case of subsequent successful conversion to AVF. 2. The most important risk factors is comorbidity, starting of HD after 65 years, diabetes and only then - vascular access type. 3. Given all the facts, in the older adults we tend to create an AVF closer to start of HD than in the general HD population.

Risk Factors in Multiple Carcinomas of the Lip

1980 ◽  
Vol 88 (3) ◽  
pp. 248-251 ◽  
Author(s):  
Shan R. Baker
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
General Population ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Prolonged Exposure ◽  
Significant Risk ◽  
Facial Skin ◽  
Actinic Cheilitis ◽  
Serologic Reaction

Certain risk factors appear to separate subjects with repeated primary carcinomas of the lip from the general population of patients with carcinoma of the lip. Factors that were found statistically significant in increasing the chance of recurrent carcinoma of the lip include outdoor occupations requiring prolonged exposure to sunlight or the use of tobacco on a regular basis. Significant risk factors of a clinical nature include a positive serologic reaction for syphilis; the presence of leukoplakia, hyperkeratosis, or actinic cheilitis; or the presence of a basal cell or squamous cell carcinoma of the facial skin.

scholarly journals Increased Risk of Diabetes Mellitus Among Adult Survivors of B-Cell Non-Hodgkin Lymphoma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4769-4769
Author(s):  
Derek K Chang ◽  
Jihye Park ◽  
Yuan Wan ◽  
Alison Fraser ◽  
Kerry Rowe ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Population ◽  
B Cell ◽  
Hodgkin Lymphoma ◽  
Significant Risk ◽  
Adult Survivors ◽  
Cancer Stage ◽  
Increased Risk ◽  
History Of

Abstract Introduction Improvements in multi-modal therapies have increased survival rates for older adults diagnosed with B-cell Non-Hodgkin Lymphoma (B-NHL). Despite this success, B-NHL survivors are at an increased risk for developing long-term and late complications of these therapies thereby compromising survival. Several studies have reported an increased risk in diabetes mellitus (DM) among long-term survivors of Hodgkin lymphoma and pediatric cancers. However, there are limited data on the risk of DM and its risk factors in older adults following treatment for B-NHL. Using data from the Utah Population Database, we evaluated the association between treatment for B-NHL and DM risk and furthermore compared this risk to a matched Utah general population. We hypothesized that the risk of DM among B-NHL survivors would be significantly increased compared to the general population. Methods Adult (age >18 years at diagnosis) survivors of primary B-NHL living in Utah at the time of diagnosis between 1997-2013, without a previous diagnosis of DM, and matched (1:4) to individuals without a prior history of DM from the Utah general population for birth year, birth state, and sex were included. New DM diagnoses were identified for all-time, 0-1, 1-5, and 5-10 years following a diagnosis of B-NHL. Adjusting for sex, race, baseline body mass index (BMI), and Charlson Comorbidity Index (CCI) scores, multivariate Cox proportional hazard analysis was performed to estimate the adjusted hazard ratio (aHR) of DM in B-NHL survivors compared with that in matched non-B-NHL individuals. Risk factors for DM were evaluated, including age at diagnosis, race, sex, BMI at baseline, family history of DM, cancer stage at diagnosis, and treatment modality. The risk of developing DM during all-time, 0 to 1, 1 to 5, and 5 to 10 years follow-up after adjusting for demographic variables was analyzed by age (< 40, 40-65, and >65 years) at diagnosis of B-NHL. Results The study population included 3,970 B-NHL survivors and 19,821 matched individuals from the general population. At the time of diagnosis, the majority of B-NHL patients were age 60 or greater (61.4%), had diffuse large B-cell lymphoma (46%) or follicular lymphoma (26.4%), distant cancer stage (50.1%), and received chemotherapy (27.5%). DM was diagnosed in 897 (22.6%) B-NHL survivors and 3,253 (16.4%) non-B-NHL adults. The majority in both groups were male (B-NHL: 55.5%; controls: 55.5%), white (B-NHL: 97.4%; controls: 93.8%), overweight [BMI 25-29.9 kg/m2 (B-NHL: 40.7%; controls: 40.6%)] or obese [BMI ≥30 kg/m2 (B-NHL: 21.8%; controls: 18.5%)]. The risk of developing DM among B-NHL survivors compared to the control group was significantly increased over all time (HR, 1.34; 95% CI 1.24 - 1.44) and the 0 to 1 year follow-up period (HR, 1.28; 95% CI 1.15 - 1.43)(Table 1). Multivariable analysis for DM risk showed that age 40-65 years and BMI ≥25 were factors independently associated with developing DM at all-time, 0 to 1, 1 to 5, and 5 to 10 years after diagnosis of B-NHL. Male sex and a family history of DM were significantly associated with development of DM during all time, 1 to 5, and 5 to 10 year follow-up periods. Distant cancer stage at diagnosis was a significant risk factor for DM at all time and 1 to 5 years while receipt of chemotherapy only or chemotherapy with radiation were significantly associated with development of DM at 5 to 10 years after diagnosis of B-NHL (estimated aHR and CIs are shown in Table 2). There was no significant association between race and the development of DM. Conclusion Adult survivors of B-NHL have an overall significantly higher risk of developing DM in the first year and over all time following a diagnosis of B-NHL compared to the general population. Age 40 to 65 years and BMI ≥25 were significant risk factors for DM across all follow-up periods while treatment with chemotherapy only or chemotherapy with radiation significantly increased the risk of DM 5-10 years after diagnosis of B-NHL. Race did not appear to be a risk factor for DM but this result may reflect the homogeneity of our study population. These findings contribute important information to the existing literature regarding the risk of developing DM in adult B-NHL survivors and provide foundation for the development of screening and management guidelines for DM in the B-NHL survivor population. Disclosures No relevant conflicts of interest to declare.

scholarly journals An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256627
Author(s):  
Julia Rozanova ◽  
Oleksandr Zeziulin ◽  
Katherine M. Rich ◽  
Frederick L. Altice ◽  
Tetiana Kiriazova ◽  
...  
Keyword(s):  
General Population ◽  
Age Groups ◽  
Treatment Strategies ◽  
Target Population ◽  
Mortality Rates ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Newly Diagnosed ◽  
Mortality Trends ◽  
Incidence And Mortality

Introduction The Eastern Europe and Central Asian (EECA) region has the highest increase in HIV incidence and mortality globally, with suboptimal HIV treatment and prevention. All EECA countries (except Russia) are low and middle-income (LMIC). While LMIC are home to 80% of all older people living with HIV (OPWH), defined as ≥50 years, extant literature observed that newly diagnosed OPWH represent the lowest proportion in EECA relative to all other global regions. We examined HIV diagnoses in OPWH in Ukraine, a country emblematic of the EECA region. Methods We analysed incident HIV diagnoses from 2015–2018 and mortality trends from 2016–2018 for three age groups: 1) 15–24 years; 2) 25–49 years; and 3) ≥50 years. AIDS was defined as CD4<200cells/mL. Mortality was defined as deaths per 1000 patients newly diagnosed with HIV within the same calendar year. Mortality rates were calculated for 2016, 2017, and 2018, compared to age-matched general population rates, and all-cause standardized mortality ratios (SMRs) were calculated. Results From 2015–2018, the proportion of OPWH annually diagnosed with HIV increased from 11.2% to 14.9% (p<0.01). At the time of diagnosis, OPWH were also significantly (p<0.01) more likely to have AIDS (43.8%) than those aged 25–49 years (29.5%) and 15–24 years (13.3%). Newly diagnosed OPWH had the same-year mortality ranging from 3 to 8 times higher than age-matched groups in the Ukrainian general population. Conclusions These findings suggest a reassessment of HIV testing, prevention and treatment strategies in Ukraine is needed to bring OPWH into focus. OPWH are more likely to present with late-stage HIV and have higher mortality rates. Re-designing testing practices is especially crucial since OPWH are absent from targeted testing programs and are increasingly diagnosed as they present with AIDS-defining symptoms. New strategies for linkage and treatment programs should reflect the distinct needs of this target population.

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