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Abstract
Increased mortality in rural patients with HIV in New England
T. Lahey1, B. Marsh1, J. Curtin1, K. Wood2, B. Eccles2, C.F. von Reyn1
Background: Although patients with human immunodeficiency virus (HIV) infection who live in the rural United States have been shown to receive less expert care and less aggressive antiretroviral treatment, the impact of living in rural areas on mortality from HIV infection is unstudied.
Methods: We compared mortality rates in 323 rural and 313 urban patients with HIV infection in the Dartmouth-Hitchcock HIV Program in a retrospective cohort study. A multivariate logistic regression model was used to correlate age, sex, race, HIV risk factor, CD4 counts, HIV viral loads, and vital status with town of residency, travel time, and insurance status. Rural areas were defined as outside the major New England cities and towns defined by the US government Office of Management and Budget.
Results: Rural patients with HIV infection were older at the end of follow up (43.4 vs. 41.4 years, p=0.002), and more likely white (93.0% vs. 78.0%, p<0.001), and a greater proportion were men who have sex with men (55.5% vs 36.1%, p<0.001). While the mean year of diagnosis was 1994 in rural patients and 1995 in urban patients (p<0.001), the mean CD4+ T cell count at presentation was similar in the two groups: 376 vs. 351 cells/microliter (p=0.298). Rural patients in our cohort were more likely to receive antiretroviral medications at any CD4 count (73.7 vs. 62.1%, p=0.0016), and received PCP prophylaxis at comparable rates (23.5% vs. 25.6%, p=0.555). Mortality was higher in rural patients (10.4% vs 6.0%, p=0.028). The risk of mortality remained higher in rural patients when adjusting for age, sex, race, HIV risk factors, year of diagnosis, travel time, lack of insurance, and receipt of antiretroviral treatment or PCP prophylaxis in a logistic regression model (OR 2.11, 1.064 to 4.218, p=0.047).
Conclusions: Patients with HIV who live in rural New England have higher mortality rates than their urban peers.
AIDS 2006 - XVI International AIDS Conference
Abstract no.
MOPE0305
Suggested Citation
"T.Lahey, et al.
Increased mortality in rural patients with HIV in New England.
:
AIDS 2006 - XVI International AIDS Conference:
Abstract no.
MOPE0305"
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