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

doi:10.1007/s11606-013-2346-z

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

Medicine

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

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 language	English (US)
Pages (from-to)	S577-S582
Journal	Journal of general internal medicine
Volume	28
Issue number	SUPPL.2
DOIs	https://doi.org/10.1007/s11606-013-2346-z
State	Published - Jul 2013

Keywords

Burden of illness
HIV
Health care disparities
Veterans
Women

ASJC Scopus subject areas

Internal Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s11606-013-2346-z

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Blackstock, O. J., Tate, J. P., Akgün, K. M., Crystal, S., Duggal, M., Edelman, E. J., Gibert, C. L., Gordon, K. S., Rimland, D., Rodriguez-Barradas, M. C., Wang, E. A., Fiellin, D. A., & 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), S577-S582. https://doi.org/10.1007/s11606-013-2346-z

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, pp. S577-S582. https://doi.org/10.1007/s11606-013-2346-z

@article{01f084f415fd47bda01ed24ca61fdee4,

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

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.",

keywords = "Burden of illness, HIV, Health care disparities, Veterans, Women",

author = "Blackstock, {Oni J.} and Tate, {Janet P.} and Akg{\"u}n, {Kathleen M.} and Stephen Crystal and Mona Duggal and Edelman, {E. Jennifer} and Gibert, {Cynthia L.} and Gordon, {Kirsha S.} and David Rimland and Rodriguez-Barradas, {Maria C.} and Wang, {Emily A.} and Fiellin, {David A.} and Justice, {Amy C.}",

note = "Funding Information: Acknowledgements: Funders: This work was supported by the National Institutes of Health: National Institute on Alcohol Abuse and Alcoholism (U10-AA13566), National Heart, Lung, and Blood Institute (R01-HL095136; R01-HL090342; RCI-HL100347), and National Institute on Aging (R01-AG029154; K23 AG024896). This work was also funded in part by the Society of General Internal Medicine{\textquoteright}s Lawrence S. Linn award to O.J.B. O.J.B. was supported by the Yale Robert Wood Johnson Foundation Clinical Scholars Program and the Department of Veterans Affairs. J. P. T. was supported by the Training Program in Environmental Epidemiology (T32 ES07069).",

year = "2013",

month = jul,

doi = "10.1007/s11606-013-2346-z",

language = "English (US)",

volume = "28",

pages = "S577--S582",

journal = "Journal of general internal medicine",

issn = "0884-8734",

publisher = "Springer New York",

number = "SUPPL.2",

}

TY - JOUR

T1 - Sex disparities in overall burden of disease among hiv-infected individuals in the veterans affairs healthcare system

AU - Blackstock, Oni J.

AU - Tate, Janet P.

AU - Akgün, Kathleen M.

AU - Crystal, Stephen

AU - Duggal, Mona

AU - Edelman, E. Jennifer

AU - Gibert, Cynthia L.

AU - Gordon, Kirsha S.

AU - Rimland, David

AU - Rodriguez-Barradas, Maria C.

AU - Wang, Emily A.

AU - Fiellin, David A.

AU - Justice, Amy C.

N1 - Funding Information: Acknowledgements: Funders: This work was supported by the National Institutes of Health: National Institute on Alcohol Abuse and Alcoholism (U10-AA13566), National Heart, Lung, and Blood Institute (R01-HL095136; R01-HL090342; RCI-HL100347), and National Institute on Aging (R01-AG029154; K23 AG024896). This work was also funded in part by the Society of General Internal Medicine’s Lawrence S. Linn award to O.J.B. O.J.B. was supported by the Yale Robert Wood Johnson Foundation Clinical Scholars Program and the Department of Veterans Affairs. J. P. T. was supported by the Training Program in Environmental Epidemiology (T32 ES07069).

PY - 2013/7

Y1 - 2013/7

N2 - 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.

AB - 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.

KW - Burden of illness

KW - HIV

KW - Health care disparities

KW - Veterans

KW - Women

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SN - 0884-8734

VL - 28

SP - S577-S582

JO - Journal of general internal medicine

JF - Journal of general internal medicine

IS - SUPPL.2

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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