February 6, 2015
A primary goal of the National HIV/AIDS Strategy is to reduce HIV-related health disparities, including HIV-related mortality in communities at high risk for human immunodeficiency virus (HIV) infection.1 As a group, persons who self-identify as blacks or African Americans (referred to as blacks in this report), have been affected by HIV more than any other racial/ethnic population. Forty-seven percent of persons who received an HIV diagnosis in the United States in 2012 and 43% of all persons living with diagnosed HIV infection in 2011 were black. Blacks also experienced a low 3-year survival rate among persons with HIV infection diagnosed during 2003-2008.2 CDC and its partners have been pursuing a high-impact prevention approach and supporting projects focusing on minorities to improve diagnosis, linkage to care, and retention in care, and to reduce disparities in HIV-related health outcomes.3 To measure trends in disparities in mortality among blacks, CDC analyzed data from the National HIV Surveillance System. The results of that analysis indicated that among blacks aged ≥13 years the death rate per 1,000 persons living with diagnosed HIV decreased from 28.4 in 2008 to 20.5 in 2012. Despite this improvement, in 2012 the death rate per 1,000 persons living with HIV among blacks was 13% higher than the rate for whites and 47% higher than the rate for Hispanics or Latinos. These data demonstrate the need for implementation of interventions and public health strategies to further reduce disparities in deaths.
Data from the National HIV Surveillance System for 2008-2012 and reported to CDC through June 2014 were used to determine the numbers of deaths and rates of death among black persons living with HIV aged ≥13 years at the time of death. Numbers and rates for the total U.S. population and for whites and Hispanics or Latinos were calculated for comparison. Two sets of death rates were calculated overall and by age, race/ethnicity and sex: 1) deaths per 100,000 population and 2) deaths per 1,000 persons living with HIV. The numerator for each rate was the estimated number of deaths by year of death. The denominators for the rates per 100,000 population were calculated using year-specific census or postcensus data (for persons aged ≥13 years) from the U.S. Census Bureau for the years 2008-2012.4 For a given year (year X), the denominator for the rate per 1,000 persons living with HIV was calculated by adding the number of new HIV diagnoses among persons aged ≥13 years during year X to the number of persons living with diagnosed HIV aged ≥13 years at the end of the year X-1. For rates by HIV transmission category, only rates per 1,000 persons living with HIV could be calculated because the U.S. Census does not collect the data needed for calculating rates per 100,000 population. The number of deaths was statistically adjusted for reporting delays and missing transmission category.5
In 2012, an estimated 8,165 (48%) deaths occurred among black persons living with HIV, which was 1.5 times the number of deaths among whites (5,426) and 3.2 times the deaths among Hispanics or Latinos (2,586). During 2008-2012, there was a consistent decline in the number of deaths and rates of death among blacks. The number of deaths decreased 18%, and rate per 100,000 population decreased 21%; rate per 1,000 persons living with HIV decreased 28%. Although deaths also decreased among other race/ethnicity groups, the decreases generally were greater and more consistent among blacks than among other races/ethnicities (Table 1).
In 2012, deaths per 1,000 persons living with HIV among blacks were higher among older persons compared with younger persons, with the highest rate (41.3) among those aged ≥55 years. By transmission category, among black males, the lowest death rate (per 1,000 persons living with HIV) was among males whose HIV infection was attributed to male-to-male sexual contact (15.3), and the highest rate was among males who had their HIV infection attributed to injection drug use (33.1). Among black females, the death rate among those with HIV infection attributed to heterosexual contact (17.9) also was lower compared with the rate among those black females with infection attributed to injection drug use (29.2). These patterns were consistent across all races/ethnicities (Table 2).
Racial/ethnic disparities varied among states. In 23 states and the District of Columbia, the death rate per 1,000 persons living with HIV in blacks was higher than that in whites, whereas in 27 states blacks had a death rate that was lower than that in whites. The rate among blacks was higher than that among Hispanics/Latinos in 37 states and the District of Columbia. In 2012, the highest and lowest rates per 1,000 persons living with HIV among blacks were in West Virginia (28.9) and Nebraska (9.3), respectively, and among the 10 states with the highest death rates per 1,000 persons living with HIV in blacks, seven were in the South. The highest and lowest rates per 100,000 population among blacks were in the District of Columbia (98.4) and Alaska (5.2), respectively, and the largest number of deaths (1,147) occurred in Florida (Table 3).
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