1995—2018年云南省某市HIV/AIDS死因别死亡率和死因变化趋势分析

Changing trends analysis on the cause-specific mortality and causes of death among HIV/AIDS patients in a prefecture of Yunnan Province,1995-2018

目的了解云南省某市1995—2018年艾滋病病毒感染者/艾滋病患者(HIV/AIDS)死因别死亡率和死因变化趋势。方法从艾滋病综合防治信息系统中下载相关资料,死因采用Co De编码系统归类,计算死因别死亡率和治疗(ART)覆盖率,采用Cox 比例风险回归模型分析不同基线CD4值、诊断时年龄和ART情况的死因别死亡风险。结果 4445例HIV/AIDS中1054例死亡。ART覆盖率由2005年的5.34%上升到2018年的91.93%,全死因死亡率从1996年的118.03/1000人年下降至2018年的24.00/1000人年,艾滋病相关疾病死因占比由2005—2007年的41.30%下降至2017—2018年的21.55%,艾滋病相关疾病死亡率由2008—2010年最高的22.78/1000人年下降至2017—2018年的6.18/1000人年。2014—2018年心脑血管和呼吸系统疾病为第2、3位死因。诊断时年龄≥ 50岁组死于心脑血管死因和呼吸系统疾病死因风险最高;未ART组死于各死因的风险均较高(均有HR>1,P<0.05);基线CD4<200个/μL组死于艾滋病相关性疾病、非艾滋病相关性肿瘤、自杀和不详的风险分别是基线CD4≥200个/μL组的6.966、2.542、4.759和2.444倍。结论随着ART覆盖率的逐渐上升,HIV/AIDS死亡率逐年下降,死因逐渐以心脑血管和呼吸系统疾病等非艾滋病相关疾病为主,应早发现、早治疗并结合死因变化采取相应措施,延长患者生存时间。

Objective To analyze the changing trends of the cause-specific mortality and causes of death among HIV/AIDS patients in a prefecture of Yunnan Province from 1995 to 2018.Methods All Data were downloaded from National Comprehensive HIV/AIDS Prevention and Care Information System.The cause-specific of the HIV/AIDS deaths were classified based on the Coding Causes of Death in HIV(CoDe) Project,and the cause-specific mortality and coverage rate of anti-retroviral therapy(ART) were calculated.Cox proportional hazard models were used to analysis risk factors of causespecific mortality among HIV/AIDS patients,which were stratified by baseline CD4 values,age at diagnosed,and ART group.Results Among 4445 cases of patients,1054 cases were dead during the follow-up period.The coverage rate of the antiretroviral therapy(ART) was increased form 5.34% in 2005 to 91.93% in 2018,while the all-cause mortality was decreased form 118.03 per 1000 person-years(PY) in 1996 to 24.00 per 1000 PY in 2018.The proportion of AIDS-related diseases cause of death was decreased from 41.30% in 2005-2007 to 21.55% in 2017-2018,and the mortality caused by AIDS-related diseases was decreased from the peak of 22.78 per 1000 PY in 2008-2010 to 6.18 per 1000 PY in 2017-2018.The cardiovascular diseases and respiratory diseases became the second and third leading cause of death in 2014-2018.The Cox proportional hazard models analysis indicated that the risk of cause-specific mortality among aged≥50 groups were higher than aged <50 groups(hazard ratio HR> 1,all P <0.05),especially the cardiovascular diseases and respiratory diseases related deaths.The patients without ART had higher risk of cause-specific mortality than those received ART(all HR> 1,P <0.05).In patients with baseline C.D4 <200 cell/μL,the risk of mortality of AIDS-related diseases,nonAIDS malignancy,suicide and unknown were 6.966,2.542,4.759 and 2.444 times higher than those baseline CD4≥200 cell/μL,respectively.Conclusion With increased coverage rate of ART,the mortality was decreased year by year,and the leading causes of death are non-AIDS-related diseases such as cardiovascular cerebrovascular and respiratory diseases.To improve the survival time among HIV/AIDS patients,earlier detection,diagnosis,and treatment should be strengthened according to the causes of death.