Gina Turrini ,Stephanie S. Chan, Pamela W. Klein, Stacy M. Cohen, Antigone Dempsey, Heather Hauck, Laura W. Cheever, Andre R. Chappel
Abstract
Nearly half of people with HIV in the United States are 50 years or older, and this proportion is growing. Between 2012 and 2016, the largest percent increase in the prevalence rate of HIV was among people aged 65 and older, the eligibility age for Medicare coverage for individuals without a disability or other qualifying condition. Previous work suggests that older people with HIV may have higher rates of chronic conditions and develop them more rapidly than older people who do not have HIV. This study compared the health status of older people with HIV with the older US population not living with HIV by comparing: (1) mortality; (2) prevalence of certain conditions, and (3) incidence of these conditions with increasing age.
Introduction
Treatments for HIV have improved significantly over the past 24 years since combination antiretroviral therapy was first introduced in 1996. HIV is now a manageable, chronic condition and individuals retained on anti-retroviral therapy have much longer life expectancies than in the past, which is contributing to an ongoing shift in the age distribution of people with HIV [1–5]. This trend, seen in the US and elsewhere [6], toward an aging of the population with HIV raises important questions regarding the health care needs of older people with HIV, how they may differ from those of older people without HIV, and how best to address those needs.
Methods
Data and samples
The data for this project came from the Centers for Medicare & Medicaid Services (CMS) Master Beneficiary Summary File (MBSF), which contains data on all individuals enrolled in Medicare in a given calendar year. Citizens and permanent residents of the United States are generally eligible for Medicare at age 65 or if they have end-stage renal disease or have a disability and have accumulated a sufficient amount of work history individually or through a spouse or parent to qualify for Social Security Disability Insurance (SSDI) or Social Security Retirement Benefits or Railroad Retirement benefits or a railroad disability annuity.
Discussion
This paper analyzed a large, nationally representative sample of Medicare beneficiaries aged 65 and older from 2011 to 2016 to compare the health and survival status of older people with HIV to an older US population not living with HIV. Prior research has found that older people with HIV have high adherence to treatment which results in high levels of viral suppression [25, 26]. Adherence to treatment and viral suppression are both associated with better health outcomes [51].
Nonetheless, we found that older people with HIV have a higher overall hazard of mortality as well as a higher odds of having depression, chronic kidney disease, COPD, osteoporosis, colorectal cancer, lung cancer, hypertension, ischemic heart disease, diabetes, chronic hepatitis, and end-stage liver disease compared to those without HIV, even after adjusting for demographic characteristics. Some of these differences were quite large in magnitude, particularly for hepatitis and end-stage liver disease. Finally, we found that the incidence of diagnosis over time of every condition analyzed is higher for people with HIV, after accounting for the competing and differential risk of mortality.
Citation:Turrini G, Chan SS, Klein PW, Cohen SM, Dempsey A, Hauck H, et al. (2020) Assessing the health status and mortality of older people over 65 with HIV. PLoS ONE 15(11): e0241833. https://doi.org/10.1371/journal.pone.0241833
Academic Editor: Kenzie Latham-Mintus, Indiana University Purdue University at Indianapolis, UNITED STATES
Received:January 8, 2020; Accepted: October 21, 2020; Published: November 5, 2020.
Data Availability: Medicare Master Beneficiary Summary File data cannot be shared publicly because of privacy and confidentiality issues. Data can be requested from ResDAC, a CMS contractor, by emailing RESDAC@umn.edu. The process for requesting data is described here: https://www.resdac.org/research-identifiable-files-rif-requests.
Funding:The authors received no specific funding for this work.
Competing interests:The authors have declared that no competing interests exist.
