Socioeconomic determinants of mortality in HIV: evidence from a clinical cohort in Uganda
Identifieur interne : 001921 ( Pmc/Corpus ); précédent : 001920; suivant : 001922Socioeconomic determinants of mortality in HIV: evidence from a clinical cohort in Uganda
Auteurs : Matthew D. Burkey ; Sheri D. Weiser ; Desiree Fehmie ; Stella Alamo-Talisuna ; Pamella Sunday ; Joy Nannyunja ; Steven J. Reynolds ; Larry W. ChangSource :
- Journal of acquired immune deficiency syndromes (1999) [ 1525-4135 ] ; 2014.
Abstract
To delineate the association between baseline socioeconomic status (SES) indicators and mortality and lost to follow-up (LTFU) in a cohort of HIV-infected individuals enrolled in antiretroviral treatment (ART) in urban Uganda.
Retrospective cohort study nested in an antiretroviral clinic-based cohort.
SES indicators including education, employment status, and a standardized wealth index, and other demographic and clinical variables were assessed at baseline among ART-treated patients in a clinic-based cohort in Kampala, Uganda. Confirmed mortality (primary outcome) and LTFU (secondary outcome) were actively ascertained over a 4-year follow-up period from 2005–2009.
Among 1763 adults (70.5% female; mean age 36.2 years (SD=8.4)) enrolled in ART, 14.4% (n=253) were confirmed dead and 19.7% (n=346) were LTFU at 4-year follow-up. No formal education (Adjusted Odds Ratio (AOR) 1.76; 95% Confidence Interval (CI): 1.19 to 2.59), having fewer than 6 dependents (AOR 1.39; 95% CI: 1.04 to 1.86), unemployment (AOR 1.98; 95% CI: 1.48 to 2.66) and housing tenure index score (a component of the wealth index) (AOR 1.11; 95% CI: 1.00 to 1.23) were significantly associated with confirmed mortality at 4 years. SES indicators were not associated with LFTU at 4 years.
Baseline SES indicators, including education, number of dependents, employment status, and components of a standard wealth index, may indicate long-term vulnerability to mortality in patients with HIV/AIDS, despite uniform access to ART. Future studies delineating the pathways through which poverty and limited assets affect clinical outcomes may lead to more effective HIV interventions in low-resource settings.
Url:
DOI: 10.1097/QAI.0000000000000094
PubMed: 24378727
PubMed Central: 3981890
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Socioeconomic determinants of mortality in HIV: evidence from a clinical cohort in Uganda</title><author><name sortKey="Burkey, Matthew D" sort="Burkey, Matthew D" uniqKey="Burkey M" first="Matthew D." last="Burkey">Matthew D. Burkey</name></author><author><name sortKey="Weiser, Sheri D" sort="Weiser, Sheri D" uniqKey="Weiser S" first="Sheri D." last="Weiser">Sheri D. Weiser</name></author><author><name sortKey="Fehmie, Desiree" sort="Fehmie, Desiree" uniqKey="Fehmie D" first="Desiree" last="Fehmie">Desiree Fehmie</name></author><author><name sortKey="Alamo Talisuna, Stella" sort="Alamo Talisuna, Stella" uniqKey="Alamo Talisuna S" first="Stella" last="Alamo-Talisuna">Stella Alamo-Talisuna</name></author><author><name sortKey="Sunday, Pamella" sort="Sunday, Pamella" uniqKey="Sunday P" first="Pamella" last="Sunday">Pamella Sunday</name></author><author><name sortKey="Nannyunja, Joy" sort="Nannyunja, Joy" uniqKey="Nannyunja J" first="Joy" last="Nannyunja">Joy Nannyunja</name></author><author><name sortKey="Reynolds, Steven J" sort="Reynolds, Steven J" uniqKey="Reynolds S" first="Steven J." last="Reynolds">Steven J. Reynolds</name></author><author><name sortKey="Chang, Larry W" sort="Chang, Larry W" uniqKey="Chang L" first="Larry W." last="Chang">Larry W. Chang</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24378727</idno><idno type="pmc">3981890</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3981890</idno><idno type="RBID">PMC:3981890</idno><idno type="doi">10.1097/QAI.0000000000000094</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">001921</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001921</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Socioeconomic determinants of mortality in HIV: evidence from a clinical cohort in Uganda</title><author><name sortKey="Burkey, Matthew D" sort="Burkey, Matthew D" uniqKey="Burkey M" first="Matthew D." last="Burkey">Matthew D. Burkey</name></author><author><name sortKey="Weiser, Sheri D" sort="Weiser, Sheri D" uniqKey="Weiser S" first="Sheri D." last="Weiser">Sheri D. Weiser</name></author><author><name sortKey="Fehmie, Desiree" sort="Fehmie, Desiree" uniqKey="Fehmie D" first="Desiree" last="Fehmie">Desiree Fehmie</name></author><author><name sortKey="Alamo Talisuna, Stella" sort="Alamo Talisuna, Stella" uniqKey="Alamo Talisuna S" first="Stella" last="Alamo-Talisuna">Stella Alamo-Talisuna</name></author><author><name sortKey="Sunday, Pamella" sort="Sunday, Pamella" uniqKey="Sunday P" first="Pamella" last="Sunday">Pamella Sunday</name></author><author><name sortKey="Nannyunja, Joy" sort="Nannyunja, Joy" uniqKey="Nannyunja J" first="Joy" last="Nannyunja">Joy Nannyunja</name></author><author><name sortKey="Reynolds, Steven J" sort="Reynolds, Steven J" uniqKey="Reynolds S" first="Steven J." last="Reynolds">Steven J. Reynolds</name></author><author><name sortKey="Chang, Larry W" sort="Chang, Larry W" uniqKey="Chang L" first="Larry W." last="Chang">Larry W. Chang</name></author></analytic><series><title level="j">Journal of acquired immune deficiency syndromes (1999)</title><idno type="ISSN">1525-4135</idno><idno type="eISSN">1944-7884</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title><p id="P1">To delineate the association between baseline socioeconomic status (SES) indicators and mortality and lost to follow-up (LTFU) in a cohort of HIV-infected individuals enrolled in antiretroviral treatment (ART) in urban Uganda.</p></sec><sec id="S2"><title>Design</title><p id="P2">Retrospective cohort study nested in an antiretroviral clinic-based cohort.</p></sec><sec id="S3"><title>Methods</title><p id="P3">SES indicators including education, employment status, and a standardized wealth index, and other demographic and clinical variables were assessed at baseline among ART-treated patients in a clinic-based cohort in Kampala, Uganda. Confirmed mortality (primary outcome) and LTFU (secondary outcome) were actively ascertained over a 4-year follow-up period from 2005–2009.</p></sec><sec id="S4"><title>Results</title><p id="P4">Among 1763 adults (70.5% female; mean age 36.2 years (SD=8.4)) enrolled in ART, 14.4% (n=253) were confirmed dead and 19.7% (n=346) were LTFU at 4-year follow-up. No formal education (Adjusted Odds Ratio (AOR) 1.76; 95% Confidence Interval (CI): 1.19 to 2.59), having fewer than 6 dependents (AOR 1.39; 95% CI: 1.04 to 1.86), unemployment (AOR 1.98; 95% CI: 1.48 to 2.66) and housing tenure index score (a component of the wealth index) (AOR 1.11; 95% CI: 1.00 to 1.23) were significantly associated with confirmed mortality at 4 years. SES indicators were not associated with LFTU at 4 years.</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">Baseline SES indicators, including education, number of dependents, employment status, and components of a standard wealth index, may indicate long-term vulnerability to mortality in patients with HIV/AIDS, despite uniform access to ART. Future studies delineating the pathways through which poverty and limited assets affect clinical outcomes may lead to more effective HIV interventions in low-resource settings.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">100892005</journal-id><journal-id journal-id-type="pubmed-jr-id">21821</journal-id><journal-id journal-id-type="nlm-ta">J Acquir Immune Defic Syndr</journal-id><journal-id journal-id-type="iso-abbrev">J. Acquir. Immune Defic. Syndr.</journal-id><journal-title-group><journal-title>Journal of acquired immune deficiency syndromes (1999)</journal-title></journal-title-group><issn pub-type="ppub">1525-4135</issn><issn pub-type="epub">1944-7884</issn></journal-meta><article-meta><article-id pub-id-type="pmid">24378727</article-id><article-id pub-id-type="pmc">3981890</article-id><article-id pub-id-type="doi">10.1097/QAI.0000000000000094</article-id><article-id pub-id-type="manuscript">NIHMS558603</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Socioeconomic determinants of mortality in HIV: evidence from a clinical cohort in Uganda</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Burkey</surname><given-names>Matthew D.</given-names></name><degrees>MD, MPH</degrees><aff id="A1">Johns Hopkins School of Medicine, Baltimore, MD</aff></contrib><contrib contrib-type="author"><name><surname>Weiser</surname><given-names>Sheri D.</given-names></name><degrees>MD, MA, MPH</degrees><aff id="A2">Division of HIV/AIDS and Center for AIDS Prevention Studies, UCSF, San Francisco, CA</aff></contrib><contrib contrib-type="author"><name><surname>Fehmie</surname><given-names>Desiree</given-names></name><degrees>MPH, MSc</degrees><aff id="A3">The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH</aff></contrib><contrib contrib-type="author"><name><surname>Alamo-Talisuna</surname><given-names>Stella</given-names></name><degrees>MD, PhD</degrees><aff id="A4">Reach Out-Mbuya, Kampala, Uganda</aff></contrib><contrib contrib-type="author"><name><surname>Sunday</surname><given-names>Pamella</given-names></name><degrees>MS</degrees><aff id="A5">Reach Out-Mbuya, Kampala, Uganda</aff></contrib><contrib contrib-type="author"><name><surname>Nannyunja</surname><given-names>Joy</given-names></name><aff id="A6">Reach Out-Mbuya, Kampala, Uganda</aff></contrib><contrib contrib-type="author"><name><surname>Reynolds</surname><given-names>Steven J.</given-names></name><degrees>MD</degrees><aff id="A7">1. Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; 2. Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD</aff></contrib><contrib contrib-type="author"><name><surname>Chang</surname><given-names>Larry W.</given-names></name><degrees>MD, MPH</degrees><aff id="A8">1. Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD; 2. Johns Hopkins Bloomberg School of Public Health</aff></contrib></contrib-group><author-notes><corresp id="FN1">Corresponding Author: Matthew D. Burkey, MD, MPH, Johns Hopkins Hospital, 1800 Orleans St, Bloomberg 12352, Baltimore, MD 21287, Fax: 410-955-8691, Phone: 410-955-4297, <email>mburkey1@jhmi.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>11</day><month>3</month><year>2014</year></pub-date><pub-date pub-type="ppub"><day>1</day><month>5</month><year>2014</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>5</month><year>2015</year></pub-date><volume>66</volume><issue>1</issue><fpage>41</fpage><lpage>47</lpage><pmc-comment>elocation-id from pubmed: 10.1097/QAI.0000000000000094</pmc-comment>
<abstract><sec id="S1"><title>Objective</title><p id="P1">To delineate the association between baseline socioeconomic status (SES) indicators and mortality and lost to follow-up (LTFU) in a cohort of HIV-infected individuals enrolled in antiretroviral treatment (ART) in urban Uganda.</p></sec><sec id="S2"><title>Design</title><p id="P2">Retrospective cohort study nested in an antiretroviral clinic-based cohort.</p></sec><sec id="S3"><title>Methods</title><p id="P3">SES indicators including education, employment status, and a standardized wealth index, and other demographic and clinical variables were assessed at baseline among ART-treated patients in a clinic-based cohort in Kampala, Uganda. Confirmed mortality (primary outcome) and LTFU (secondary outcome) were actively ascertained over a 4-year follow-up period from 2005–2009.</p></sec><sec id="S4"><title>Results</title><p id="P4">Among 1763 adults (70.5% female; mean age 36.2 years (SD=8.4)) enrolled in ART, 14.4% (n=253) were confirmed dead and 19.7% (n=346) were LTFU at 4-year follow-up. No formal education (Adjusted Odds Ratio (AOR) 1.76; 95% Confidence Interval (CI): 1.19 to 2.59), having fewer than 6 dependents (AOR 1.39; 95% CI: 1.04 to 1.86), unemployment (AOR 1.98; 95% CI: 1.48 to 2.66) and housing tenure index score (a component of the wealth index) (AOR 1.11; 95% CI: 1.00 to 1.23) were significantly associated with confirmed mortality at 4 years. SES indicators were not associated with LFTU at 4 years.</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">Baseline SES indicators, including education, number of dependents, employment status, and components of a standard wealth index, may indicate long-term vulnerability to mortality in patients with HIV/AIDS, despite uniform access to ART. Future studies delineating the pathways through which poverty and limited assets affect clinical outcomes may lead to more effective HIV interventions in low-resource settings.</p></sec></abstract><kwd-group><kwd>HIV</kwd><kwd>Socioeconomic status</kwd><kwd>Lost to follow-up</kwd><kwd>Mortality</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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