Sex disparities in overall burden of disease among hiv-infected individuals in the veterans affairs healthcare system

Oni J. Blackstock, Janet P. Tate, Kathleen M. Akgün, Stephen Crystal, Mona Duggal, E. Jennifer Edelman, Cynthia L. Gibert, Kirsha S. Gordon, David Rimland, Maria C. Rodriguez-Barradas, Emily A. Wang, David A. Fiellin, Amy C. Justice

Research output: Contribution to journalArticle

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Abstract

Background: Whether sex disparities exist in overall burden of disease among human immunodeficiency virus (HIV)-infected individuals in the Veterans Affairs healthcare system (VA) is unknown. Objective: To determine whether sex differences exist in overall burden of disease after 1 year of combined antiretroviral therapy (ART) among HIV-infected individuals in VA. Design: Retrospective cohort study. Participants: Among patients in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC), all ART-naïve HIV-infected Veterans who received VA-based HIV care between 1996 and 2009. Main Measures: Overall burden of disease was measured using the VACS Index, an index that incorporates HIV (e.g. CD4 cell count) and non-HIV biomarkers (e.g. hemoglobin) and is highly predictive of allcause mortality. Possible scores range from 0 to 164, although scores typically range from 0 to 50 for 80 % of patients in VACS-VC. A higher score indicates greater burden of disease (each additional five points indicates approximately 20 % increased 5-year mortality risk). ART adherence was measured using pharmacy data. Key Results: Complete data were available for 227 women and 8,073 men. At ART initiation, compared with men, women were younger and more likely to be Black, less likely to have liver dysfunction, but more likely to have lower hemoglobin levels. Median VACS Index scores changed fromART initiation to 1 year after ART initiation: women's scores went from 41 to 28 for women (13 point improvement) and men's from 42 to 27 for men (15 point improvement). In multivariable regression, women had 3.6 point worse scores than men after 1 year on ART (p= 0.002); this difference decreased to 3.2 points after adjusting for adherence (p=0.004). Conclusions: In VA, compared to men, women experienced less improvement in overall burden of disease after 1 year ofHIVtreatment. Further study is needed to elucidate the modifiable factors that may explain this disparity.

Original languageEnglish (US)
JournalJournal of General Internal Medicine
Volume28
Issue numberSUPPL.2
DOIs
StatePublished - Jul 2013

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Veterans
Delivery of Health Care
HIV
Cohort Studies
Hemoglobins
Therapeutics
Mortality
CD4 Lymphocyte Count
Sex Characteristics
Liver Diseases
Retrospective Studies
Biomarkers
Viruses

Keywords

  • Burden of illness
  • Health care disparities
  • HIV
  • Veterans
  • Women

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Blackstock, O. J., Tate, J. P., Akgün, K. M., Crystal, S., Duggal, M., Edelman, E. J., ... Justice, A. C. (2013). Sex disparities in overall burden of disease among hiv-infected individuals in the veterans affairs healthcare system. Journal of General Internal Medicine, 28(SUPPL.2). https://doi.org/10.1007/s11606-013-2346-z

Sex disparities in overall burden of disease among hiv-infected individuals in the veterans affairs healthcare system. / Blackstock, Oni J.; Tate, Janet P.; Akgün, Kathleen M.; Crystal, Stephen; Duggal, Mona; Edelman, E. Jennifer; Gibert, Cynthia L.; Gordon, Kirsha S.; Rimland, David; Rodriguez-Barradas, Maria C.; Wang, Emily A.; Fiellin, David A.; Justice, Amy C.

In: Journal of General Internal Medicine, Vol. 28, No. SUPPL.2, 07.2013.

Research output: Contribution to journalArticle

Blackstock, OJ, Tate, JP, Akgün, KM, Crystal, S, Duggal, M, Edelman, EJ, Gibert, CL, Gordon, KS, Rimland, D, Rodriguez-Barradas, MC, Wang, EA, Fiellin, DA & Justice, AC 2013, 'Sex disparities in overall burden of disease among hiv-infected individuals in the veterans affairs healthcare system', Journal of General Internal Medicine, vol. 28, no. SUPPL.2. https://doi.org/10.1007/s11606-013-2346-z
Blackstock, Oni J. ; Tate, Janet P. ; Akgün, Kathleen M. ; Crystal, Stephen ; Duggal, Mona ; Edelman, E. Jennifer ; Gibert, Cynthia L. ; Gordon, Kirsha S. ; Rimland, David ; Rodriguez-Barradas, Maria C. ; Wang, Emily A. ; Fiellin, David A. ; Justice, Amy C. / Sex disparities in overall burden of disease among hiv-infected individuals in the veterans affairs healthcare system. In: Journal of General Internal Medicine. 2013 ; Vol. 28, No. SUPPL.2.
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abstract = "Background: Whether sex disparities exist in overall burden of disease among human immunodeficiency virus (HIV)-infected individuals in the Veterans Affairs healthcare system (VA) is unknown. Objective: To determine whether sex differences exist in overall burden of disease after 1 year of combined antiretroviral therapy (ART) among HIV-infected individuals in VA. Design: Retrospective cohort study. Participants: Among patients in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC), all ART-na{\"i}ve HIV-infected Veterans who received VA-based HIV care between 1996 and 2009. Main Measures: Overall burden of disease was measured using the VACS Index, an index that incorporates HIV (e.g. CD4 cell count) and non-HIV biomarkers (e.g. hemoglobin) and is highly predictive of allcause mortality. Possible scores range from 0 to 164, although scores typically range from 0 to 50 for 80 {\%} of patients in VACS-VC. A higher score indicates greater burden of disease (each additional five points indicates approximately 20 {\%} increased 5-year mortality risk). ART adherence was measured using pharmacy data. Key Results: Complete data were available for 227 women and 8,073 men. At ART initiation, compared with men, women were younger and more likely to be Black, less likely to have liver dysfunction, but more likely to have lower hemoglobin levels. Median VACS Index scores changed fromART initiation to 1 year after ART initiation: women's scores went from 41 to 28 for women (13 point improvement) and men's from 42 to 27 for men (15 point improvement). In multivariable regression, women had 3.6 point worse scores than men after 1 year on ART (p= 0.002); this difference decreased to 3.2 points after adjusting for adherence (p=0.004). Conclusions: In VA, compared to men, women experienced less improvement in overall burden of disease after 1 year ofHIVtreatment. Further study is needed to elucidate the modifiable factors that may explain this disparity.",
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AU - Duggal, Mona

AU - Edelman, E. Jennifer

AU - Gibert, Cynthia L.

AU - Gordon, Kirsha S.

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