2017-2019年贵阳市HIV/AIDS死亡病例特征及死因分析

Analysis on the characteristics and causes of death of HIV/AIDS patients in guiyang from 2017 to 2019

目的了解并分析贵阳市2017-2019年艾滋病病毒感染者/艾滋病患者(HIV/AIDS)死亡病例的特征和死亡原因及分布情况,以便有效采取措施降低死亡率。方法从中国疾病预防控制信息系统艾滋病综合防治信息系统中收集贵阳市2017-2019年报告HIV/AIDS死亡病例的个案资料进行分析。结果2017-2019年贵阳市共报告HIV/AIDS死亡病例604例,近3年艾滋病死亡率(χ^(2)_(趋势)=104.842,P<0.001)和病死率(χ^(2)_(趋势)=58.259,P<0.001)有明显的上升趋势;死亡病例中,≥60岁年龄段占53.6%,初中及以下文化程度占82.3%,农民及工人占41.7%,离异或丧偶占46.4%,异性传播占88.7%,接受高效抗反转录病毒(ART)治疗占35.8%,未治疗的占64.2%,基线CD4计数<350μL^(-1)的占43.5%,艾滋病无关死亡占78.6%,艾滋病相关死亡占16.1%,无法判定的占5.3%;病例报告后生存时间<1年占48.0%。单因素分析死因分布结果显示,艾滋病相关死亡与年龄(χ^(2)=23.994,P<0.001)、文化程度(χ^(2)=8.328,P=0.016)、感染途径(χ2=15.071,P=0.001)、是否接受抗病毒治疗(χ^(2)=6.384,P=0.012)及基线CD4细胞计数(χ^(2)=21.410,P=0.003)有关;二元Logistic回归多因素分析结果显示,60~<80岁(OR=3.78,95%CI为1.82~7.82,P<0.001)、小学以下文化水平(OR=2.39,95%CI为1.30~4.40,P=0.005)发生艾滋病无关死亡风险较高。结论贵阳市2017-2019年艾滋病死亡率和病死率明显上升,要降低艾滋病死亡率,需进一步扩大HIV检测,尽早发现病例,接受规范管理治疗;加强基层社区和乡镇卫生机构对艾滋病的诊疗能力,规范死因填报要求。同时对高危人群进行有效的艾滋病健康教育和干预,做到早检测和早治疗。

Objective To understand and analyze the characteristics,causes and distribution of human immunodeficiency virus/acquired immuno deficiency syndrome(HIV/AIDS)deaths in Guiyang City from 2017 to 2019,so as to take effective measures to reduce the mortality rate.Methods The case data of HIV/AIDS deaths in Guiyang City from 2017 to 2019 were collected from the AIDS Integrated Prevention and Control Information System of the Chinese Disease Control and Prevention Information System for analysis.Results A total of 604 deaths were reported in Guiyang City from 2017 to2019,the mortality rate and case fatality rate of AIDS in nearly three years had obvious rising trend(χt2 rend=104.842 and58.259,both P<0.001).In the death cases,aged 60 and above age group(53.6%),junior middle school and the following education accounted for 82.3%,farmers and workers accounted for 41.7%,divorced or widowed 46.4%,heterosexual transmission accounted for 88.7%,received effective antiretroviral therapy(ART)accounted for 35.8%,untreated(64.2%),baseline CD4 count<350μl^(-1) accounted for 43.5%,had nothing to do AIDS deaths(78.6%),AIDS related deaths accounted for 16.1%,unable to determine the accounted for 5.3%.The survival time after case report was less than one year in 48.0%.Univariate analysis showed that AIDS-related death was correlated with age(χ^(2)=23.994,P<0.001),education level(χ^(2)=8.328,P=0.016),route of infection(χ^(2)=15.071,P=0.001),receiving or not antiviral therapy(χ^(2)=6.384,P=0.012),and baseline CD4 cell count(χ^(2)=21.410,P=0.003).The results of binary Logistic regression multivariate analysis showed that the risk of AIDS-unrelated death was higher for people aged 60-<80 years(OR=3.78,95%CI:1.82-7.82,P<0.001)and those with education level below primary school(OR=2.39,95%CI:1.30-4.40,P=0.005).Conclusions The mortality rate and case fatality rate of AIDS increase significantly in Guiyang City from 2017 to 2019.To reduce the mortality rate of AIDS,HIV testing should be further expanded,cases should be detected as early as possible,and standardized management and treatment should be accepted.We should strengthen the capacity of community-level and township health institutions to diagnose and treat AIDS,and standardize the requirements for cause of death reporting.At the same time,effective AIDS health education and intervention should be carried out for highrisk groups,so as to achieve early detection and early treatment.