Disparities among US states in HIV-related mortality in persons with HIV infection, 2001-2007

David B. Hanna, Richard M. Selik, Tian Tang, Stephen J. Gange

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Objective: To examine interstate variation in US HIV case-fatality rates, and compare them with corresponding conventional HIV death rates. Design: Cross-sectional analysis using data on deaths due to HIV infection from the National Vital Statistics System and data on persons 15 years or older living with HIV infection in 2001-2007 in 37 US states from the national HIV/AIDS Reporting System. Methods: State rankings by age-adjusted HIV case-fatality rates (with HIV-infected population denominators) were compared with rankings by conventional death rates (with general population denominators). Negative binomial regression determined case-fatality rate ratios among states, adjusted for age, sex, race/ethnicity, year, and state-level markers of late HIV diagnosis. Results: On the basis of 3096729 HIV-infected person-years, the overall HIV case-fatality rate was 20.6 per 1000person-years [95% confidence interval (CI) 20.3-20.9]. Age-adjusted rates by state ranged from 9.6 (95% CI 6.8-12.4) in Idaho to 32.9 (95% CI 29.8-36.0) in Mississippi, demonstrating significant differences across states, even after adjusting for race/ethnicity (P<0.0001). Many states with low conventional death rates had high case-fatality rates. Nine of the 10 states with the highest case-fatality rates were located in the southern United States. Conclusion: Case-fatality rates complement and are not entirely concordant with conventional death rates. Interstate differences in these rates may reflect differences in secondary and tertiary prevention of HIV-related mortality among infected persons. These data suggest that state-specific contextual barriers to care may impede improvements in quality and disparities of healthcare without targeted interventions.

Original languageEnglish (US)
Pages (from-to)95-103
Number of pages9
Issue number1
StatePublished - Jan 2 2012
Externally publishedYes


  • United States
  • case-fatality rate
  • excess mortality
  • geographic factors
  • healthcare disparities
  • mortality determinants
  • surveillance

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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