TY - JOUR
T1 - Racial/ethnic differences in the association between alcohol use and mortality among men living with HIV
AU - Bensley, Kara M.
AU - McGinnis, Kathleen A.
AU - Fiellin, David A.
AU - Gordon, Adam J.
AU - Kraemer, Kevin L.
AU - Bryant, Kendall J.
AU - Edelman, E. Jennifer
AU - Crystal, Stephen
AU - Gaither, Julie R.
AU - Korthuis, P. Todd
AU - Marshall, Brandon D.L.
AU - Ornelas, India J.
AU - Chan, K. C.Gary
AU - Dombrowski, Julia C.
AU - Fortney, John C.
AU - Justice, Amy C.
AU - Williams, Emily C.
N1 - Funding Information:
The funders of this study had no role in study design, data collection, analysis, interpretation and presentation, or in the decision to submit the manuscript for publication. Views presented in the manuscript are those of the authors and do not reflect those of the University of Washington, the National Institute on Alcohol Abuse and Alcoholism, the National Institutes of Health, the Department of Veterans Affairs, or the United States Government. This study was supported by the COMpAAAS/Veterans Aging Cohort Study, which is a CHAART Cooperative Agreement funded by the National Institutes of Health: National Institute on Alcohol Abuse and Alcoholism (U24-AA020794, U01-AA020790, U01-AA020795,U01-AA020799; U10 AA013566-completed) and in kind by the US Department of Veterans Affairs. This study was additionally funded by a 2017 Small Grant from the Alcohol and Drug Abuse Institute at the University of Washington (PI: Kara Bensley), and by a 2017 Pre-doctoral Fellowship from VA Puget Sound Research & Development awarded to Dr. Bensley. Dr. Bensley is also supported by Award Number T32AA007240, Graduate Research Training in Alcohol Problems: Alcohol-related Disparities, from the National Institute on Alcohol Abuse and Alcoholism. Dr. Williams is funded through a VA Health Services Research & Development Career Development Award (CDA 12-276).
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/12/27
Y1 - 2018/12/27
N2 - Background: Increasing alcohol use is associated with increased risk of mortality among patients living with HIV (PLWH). This association varies by race/ethnicity among general outpatients, but racial/ethnic variation has not been investigated among PLWH, among whom racial/ethnic minorities are disproportionately represented. Methods: VA electronic health record data from the Veterans Aging Cohort Study (2008-2012) were used to describe and compare mortality rates across race/ethnicity and levels of alcohol use defined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. Within each racial/ethnic group, Cox proportional hazards models, adjusted for age, disease severity, and comorbidities, compared mortality risk for moderate-risk (AUDIT-C = 4-7) and high-risk (AUDIT-C ≥ 8) relative to lower-risk (AUDIT-C = 1-3) alcohol use. Results: Mean follow-up time among black (n = 8518), Hispanic (n = 1353), and white (n = 7368) male PLWH with documented AUDIT-C screening (n = 17,239) was 4.3 years. Black PLWH had the highest mortality rate among patients reporting lower-risk alcohol use (2.9/100 person-years) relative to Hispanic and white PLWH (1.8 and 2.3, respectively) (p value for overall comparison = 0.011). Mortality risk was increased for patients reporting high-risk relative to lower-risk alcohol use in all racial/ethnic groups [black adjusted hazard ratio (AHR) = 1.36, 95% confidence interval (CI) 1.12-1.66; Hispanic AHR = 2.18, 95% CI 1.30-3.64; and white AHR = 2.04, 95% CI 1.61-2.58]. For only white PLWH, mortality risk was increased for patients reporting moderate-relative to lower-risk alcohol use (black AHR = 1.09, 95% CI 0.93-1.27; Hispanic AHR = 1.36, 95% CI 0.89-2.09; white AHR = 1.51, 95% CI 1.28-1.77). Conclusion: Among all PLWH, mortality risk was increased among patients reporting high-risk alcohol use across all racial/ethnic groups, but mortality risk was only increased among patients reporting moderate-risk relative to lower-risk alcohol use among white PLWH, and black patients appeared to have higher mortality risk relative to white patients at lower-risk levels of alcohol use. Findings of the present study further underscore the need to address unhealthy alcohol use among PLWH, and future research is needed to understand mechanisms underlying observed differences.
AB - Background: Increasing alcohol use is associated with increased risk of mortality among patients living with HIV (PLWH). This association varies by race/ethnicity among general outpatients, but racial/ethnic variation has not been investigated among PLWH, among whom racial/ethnic minorities are disproportionately represented. Methods: VA electronic health record data from the Veterans Aging Cohort Study (2008-2012) were used to describe and compare mortality rates across race/ethnicity and levels of alcohol use defined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. Within each racial/ethnic group, Cox proportional hazards models, adjusted for age, disease severity, and comorbidities, compared mortality risk for moderate-risk (AUDIT-C = 4-7) and high-risk (AUDIT-C ≥ 8) relative to lower-risk (AUDIT-C = 1-3) alcohol use. Results: Mean follow-up time among black (n = 8518), Hispanic (n = 1353), and white (n = 7368) male PLWH with documented AUDIT-C screening (n = 17,239) was 4.3 years. Black PLWH had the highest mortality rate among patients reporting lower-risk alcohol use (2.9/100 person-years) relative to Hispanic and white PLWH (1.8 and 2.3, respectively) (p value for overall comparison = 0.011). Mortality risk was increased for patients reporting high-risk relative to lower-risk alcohol use in all racial/ethnic groups [black adjusted hazard ratio (AHR) = 1.36, 95% confidence interval (CI) 1.12-1.66; Hispanic AHR = 2.18, 95% CI 1.30-3.64; and white AHR = 2.04, 95% CI 1.61-2.58]. For only white PLWH, mortality risk was increased for patients reporting moderate-relative to lower-risk alcohol use (black AHR = 1.09, 95% CI 0.93-1.27; Hispanic AHR = 1.36, 95% CI 0.89-2.09; white AHR = 1.51, 95% CI 1.28-1.77). Conclusion: Among all PLWH, mortality risk was increased among patients reporting high-risk alcohol use across all racial/ethnic groups, but mortality risk was only increased among patients reporting moderate-risk relative to lower-risk alcohol use among white PLWH, and black patients appeared to have higher mortality risk relative to white patients at lower-risk levels of alcohol use. Findings of the present study further underscore the need to address unhealthy alcohol use among PLWH, and future research is needed to understand mechanisms underlying observed differences.
KW - Alcohol use
KW - HIV
KW - Mortality risk
KW - Racial/ethnic disparities
KW - Veterans
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U2 - 10.1186/s13722-017-0103-z
DO - 10.1186/s13722-017-0103-z
M3 - Article
C2 - 29353555
AN - SCOPUS:85060875994
SN - 1940-0632
VL - 13
JO - Addiction science & clinical practice
JF - Addiction science & clinical practice
IS - 1
M1 - 2
ER -