Characteristics and risk factors of early death among newly diagnosed HIV/AIDS in China, 2011-2020
-
摘要:
目的 了解中国新报告HIV/AIDS短期内死亡(诊断后一年内的死亡)的流行病学特征、时间趋势和相关影响因素, 为制定降低HIV/AIDS病死率相关政策提供依据。 方法 数据来源于中国疾病预防控制信息系统, 对2011-2020年新报告的15岁及以上的HIV/AIDS短期内死亡情况进行分析, 采用Joinpoint回归模型分析短期内死亡比例随时间变化趋势, 采用多因素logistic回归分析模型和无序多分类logistic回归分析模型探讨HIV/AIDS短期内死亡的影响因素。 结果 新报告HIV/AIDS在诊断后一年内死亡的比例为10.68%。2011-2015年新报告HIV/AIDS短期内死亡比例呈快速下降趋势, 年度变化百分比(annual percentage change, APC)(%, 95%CI)为-9.95(-11.29~-8.59)。多元logistic回归分析模型分析结果显示, 男性[OR (95% CI)= 1.60(1.57~1.63)]、年龄≥30岁[30~ < 45岁年龄组: OR (95% CI)=1.89(1.83~1.95);45~ < 60岁年龄组: OR (95% CI)=2.73(2.64~2.81);≥60岁年龄组: OR (95% CI)=4.39(4.25~4.53)]、初中及以下文化程度[OR (95% CI)=1.59(1.55~1.63)]、感染途径为异性性传播[OR (95% CI)=1.81(1.76~1.86)]和注射毒品[OR (95% CI)=1.86(1.77~1.96)]、通过医疗机构[OR (95% CI)=3.33(3.23~3.43)]和自愿咨询检测[OR (95% CI)=2.13(2.06~2.20)]发现、首次CD4+T淋巴细胞计数 < 200个/mm3[OR (95% CI)=4.83(4.75~4.92)]和未在30 d内启动抗病毒治疗[OR (95% CI)=2.69(2.64~2.74)]的感染者短期内死亡风险相对较高。无序多分类logistic回归分析模型分析结果提示, 相较于非短期内死亡感染者, 诊断后一年内不同时间段死亡的风险因素基本一致。 结论 中国HIV/AIDS诊断后短期内死亡比例较高, 应继续加强扩大检测, 促进早发现、早治疗, 持续巩固HIV防治工作, 降低HIV/AIDS病死率。 Abstract:Objective To understand epidemiological characteristics, trends and related factors associated with early death (death within one year after diagnosis) among newly diagnosed HIV/AIDS in China, providing evidence for policy making to reduce mortality of HIV/AIDS. Methods Data between 2011 and 2020 on early death among newly diagnosed HIV/AIDS aged ≥15 years old were collected from China Information System for Disease Control and Prevention.Joinpoint regression model was adopted to analyze the trend of early mortality.Multivariate and multinominal logistic regression was performed to explore risk factors of early death among HIV/AIDS. Results Of newly diagnosed HIV/AIDS patients, 10.68% died within one year after diagnosis.The proportion of early death declined quickly between 2011 and 2015[annual percentage change annual percentage change (APC)(%, 95%CI)=-9.95(-11.29--8.59)].Multivariate logistic regression indicated that male[OR (95% CI)=1.60(1.57-1.63)], age ≥ 30 years old[30- < 45 years old: OR (95% CI)=1.89(1.83-1.95);45- < 60 years old: OR (95% CI)=2.73(2.64-2.81);≥60 years old: OR (95% CI)=4.39(4.25-4.53)], having a middle school education or lower[OR (95% CI)=1.59(1.55-1.63)], heterosexual[OR (95% CI)=1.81(1.76-1.86)]and inject drug[OR (95% CI)=1.86(1.77-1.96)]transmission, diagnosed by medical institutions[OR (95% CI)=3.33(3.23-3.43)], voluntary counseling and test[OR (95% CI)=2.13(2.06-2.20)], baseline CD4+T lymphocyte count lower than 200/mm3[OR (95% CI)=4.83(4.75-4.92)], and failure to initiate antiretroviral treatment within 30 days after diagnosis[OR (95% CI)=2.69(2.64-2.74)]increased the risk of early death.Multinominal logistic regression indicated that risk factors of early death remained consistent among HIV/AIDS who died within different time frames. Conclusions There is a high proportion of early death among HIV/AIDS patients in China.Intensified efforts to enhance HIV screening and promote timely initiation of ART are needed.Continued commitment to HIV prevention and treatment is essential to reduce HIV/AIDS mortality. -
Key words:
- HIV/AIDS /
- Death /
- Risk factors
-
表 1 2011―2020年中国新报告短期内死亡HIV/AIDS人口学和疾病特征
Table 1. Characteristics of early death among newly diagnosed HIV/AIDS in China, 2011-2020
变量及分类 短期内死亡/[人数(占比/%)] χ2值 P值 变量及分类 短期内死亡/[人数(占比/%)] χ2值 P值 是 否 是 否 性别 2 275.91 < 0.001 检测来源 34 563.18 < 0.001 男 97 682(82.66) 756 313(76.49) 医疗机构 94 317(79.81) 509 711(51.55) 女 20 496(17.34) 232 440(23.51) 自愿咨询检测 16 376(13.86) 274 762(27.79) 年龄组/岁 51 145.96 < 0.001 其他来源 7 485(6.33) 204 280(20.66) 15~ < 30 7 421(6.28) 255 594(25.85) 首次CD4计数/(个·mm-3) 383 531.32 < 0.001 30~ < 45 26 944(22.80) 317 331(32.10) 未检测 54 776(46.35) 15 491(1.57) 45~ < 60 36 430(30.83) 250 381(25.32) 0~ < 200 44 316(37.50) 284 983(28.82) ≥60 47 383(40.09) 165 447(16.73) 200~ < 350 9 668(8.18) 293 587(29.69) 文化程度 19 063.02 < 0.001 350~ < 500 5 289(4.48) 216 619(21.91) 初中及以下 103 001(87.16) 668 707(67.63) ≥500 4 129(3.49) 178 073(18.01) 高中及以上 15 177(12.84) 320 046(32.37) 诊断30 d内启动治疗 33 455.94 < 0.001 感染途径 21 618.39 < 0.001 否 93 425(79.05) 504 223(51.00) 异性性传播 103 224(87.35) 681 559(68.93) 是 24 753(20.95) 484 530(49.00) 同性性传播 8 882(7.51) 259 645(26.26) 注射毒品 4 089(3.46) 40 427(4.09) 其他途径 1 983(1.68) 7 122(0.72) 
下载: 导出CSV
表 2 2011―2020年中国HIV/AIDS短期内死亡人数及比例
Table 2. Proportion of early death among newly diagnosed HIV/AIDS in China, 2011-2020
年份/年 总体 15~ < 30岁 30~ < 45岁 45~ < 60岁 ≥60岁 2011[人数(占比/%)] 10 194(15.20) 956(5.85) 3 304(12.07) 2 866(20.72) 3 068(32.32) 2012[人数(占比/%)] 10 457(13.75) 878(4.68) 3 202(10.75) 3 084(18.68) 3 293(29.97) 2013[人数(占比/%)] 10 216(12.08) 710(3.27) 3 002(9.70) 3 110(16.21) 3 394(26.68) 2014[人数(占比/%)] 10 618(10.88) 820(3.08) 2 834(8.43) 3 372(14.93) 3 592(24.29) 2015[人数(占比/%)] 11 003(9.95) 775(2.50) 2 658(7.40) 3 457(13.33) 4 113(23.11) 2016[人数(占比/%)] 11 857(9.98) 752(2.42) 2 651(7.20) 3 661(12.39) 4 793(22.42) 2017[人数(占比/%)] 12 825(9.86) 718(2.32) 2 590(6.69) 3 988(11.50) 5 529(21.58) 2018[人数(占比/%)] 14 354(9.97) 691(2.17) 2 566(6.28) 4 389(11.11) 6 708(21.14) 2019[人数(占比/%)] 14 159(9.55) 619(2.08) 2 232(5.98) 4 399(10.03) 6 909(18.56) 2020[人数(占比/%)] 12 495(9.61) 502(2.01) 1 905(5.79) 4 104(9.98) 5 984(19.24) APC(%, 95% CI)①, ② -9.95(-11.29~-8.59)③ -18.83(-23.54~-13.83)③ -11.39(-12.64~-10.12)③ -10.70(-13.11~-8.23)③ -9.20(-15.94~-1.93)③ APC(%, 95% CI)④ -0.63(-1.61~0.35) -3.87(-8.61~1.12) -5.30(-6.43~-4.17)② -5.89(-7.56~-4.2)③ -4.25(-6.31~-2.14)③ 注：1. APC: 年度变化百分比。2. 括号内为短期内死亡感染者数占当年全部报告数比例。
①总体、15~ < 30岁、30~ < 45岁和45~ < 60岁以2015年为转折点，≥60岁以2014年为转折点。②表示APC转折点前。③ APC差异有统计学意义(P < 0.05)。④表示APC转折点后。
下载: 导出CSV
表 3 中国短期内死亡HIV/AIDS多元logistic回归和无序多分类logistic回归分析模型分析
Table 3. Multivariate and multinominal logistic regression analysis of early death among newly diagnosed HIV/AIDS in China
变量及分类 多因素二分类logistic回归 无序多分类logistic回归① 0~ < 1月 1~ < 3月 3~ < 6月 6~ < 12月 性别 男性 1.60(1.57~1.63) 1.71(1.65~1.77) 1.60(1.55~1.66) 1.58(1.53~1.64) 1.54(1.49~1.59) 女性 1.00 1.00 1.00 1.00 1.00 年龄组/岁 15~ < 30 1.00 1.00 1.00 1.00 1.00 30~ < 45 1.89(1.83~1.95) 2.12(2.01~2.23) 2.02(1.90~2.14) 1.82(1.71~1.93) 1.65(1.56~1.74) 45~ < 60 2.73(2.64~2.81) 3.23(3.07~3.41) 2.95(2.78~3.13) 2.48(2.33~2.63) 2.33(2.21~2.46) ≥60 4.39(4.25~4.53) 3.91(3.70~4.12) 4.29(4.05~4.56) 4.21(3.95~4.48) 4.77(4.52~5.04) 文化程度 初中及以下 1.59(1.55~1.63) 1.38(1.33~1.44) 1.61(1.54~1.67) 1.69(1.61~1.76) 1.73(1.66~1.80) 高中及以上 1.00 1.00 1.00 1.00 1.00 感染途径 同性性传播 1.00 1.00 1.00 1.00 1.00 异性性传播 1.81(1.76~1.86) 1.55(1.48~1.63) 1.69(1.60~1.77) 2.05(1.93~2.17) 2.05(1.95~2.16) 注射毒品 1.86(1.77~1.96) 0.99(0.91~1.08) 1.44(1.31~1.58) 2.31(2.10~2.53) 3.09(2.86~3.33) 其他途径 2.14(1.98~2.30) 1.83(1.64~2.04) 1.84(1.62~2.08) 2.56(2.25~2.91) 2.53(2.24~2.86) 检测来源 医疗机构 3.33(3.23~3.43) 5.11(4.85~5.39) 3.75(3.55~3.97) 3.09(2.92~3.26) 2.38(2.27~2.48) 自愿咨询检测 2.13(2.06~2.20) 2.75(2.58~2.92) 2.44(2.29~2.59) 2.09(1.96~2.23) 1.65(1.57~1.74) 其他来源 1.00 1.00 1.00 1.00 1.00 首次CD4计数/(个·mm-3) ≥200 1.00 1.00 1.00 1.00 1.00 0~ < 200 4.83(4.75~4.92) 8.18(7.79~8.58) 6.87(6.62~7.14) 4.95(4.78~5.13) 3.12(3.03~3.21) 未检测 72.97(71.22~74.77) 363.01(346.16~380.69) 79.42(76.11~82.87) 34.85(33.38~36.39) 14.71(14.14~15.31) 诊断30 d内启动治疗 否 2.69(2.64~2.74) 4.51(4.34~4.69) 2.12(2.06~2.18) 2.59(2.50~2.67) 2.51(2.44~2.58) 是 1.00 1.00 1.00 1.00 1.00 注：1. 表中数值为OR值(95% CI)。
①无序多分类logistic回归分析模型以非短期内死亡者作为对照组，各组与对照组进行比较分析。
下载: 导出CSV
-
[1] Simon V, Ho DD, Abdool Karim Q. HIV/AIDS epidemiology, pathogenesis, prevention, and treatment[J]. Lancet, 2006, 368(9534): 489-504. DOI: 10.1016/S0140-6736(06)69157-5. [2] 甘秀敏, 赵德才, 赵燕, 等. 2003-2021年中国艾滋病抗病毒治疗工作进展情况分析[J]. 中国艾滋病性病, 2022, 28(6): 642-646. DOI: 10.13419/j.cnki.aids.2022.06.04.Gan XM, Zhao DC, Zhao Y, et al. Progress on national antiretroviral treatment program during 2003-2021 in China[J]. Chin J AIDS STD, 2022, 28(6): 642-646. DOI: 10.13419/j.cnki.aids.2022.06.04. [3] 蔡畅, 汤后林, 李东民, 等. 我国艾滋病患者的死亡趋势及其相关危险因素分析[J]. 中华流行病学杂志, 2021, 42(1): 121-125. DOI: 10.3760/cma.j.cn112338-20200918-01169.Cai C, Tang HL, Li DM, et al. Analysis on death trend in AIDS patients and related risk factors in China[J]. Chin J Epidemiol, 2021, 42(1): 121-125. DOI: 10.3760/cma.j.cn112338-20200918-01169.j.cn112338-20200918-01169. [4] 冉克飞, 杨景元, 武玉梅, 等. 2016-2019年内蒙古自治区HIV/AIDS死亡病例分析[J]. 热带医学杂志, 2022, 22(2): 287-290. DOI: 10.3969/j.issn.1672-3619.2022.02.032.Ran KF, Yang JY, Wu YM, et al. Analysis on HIV/AIDS death cases in Inner Mongolia Autonomous Region, from 2016 to 2019[J]. J Trop Med, 2022, 22(2): 287-290. DOI: 10.3969/j.issn.1672-3619.2022.02.032. [5] Leite PHAC, Coelho LE, Cardoso SW, et al. Early mortality in a cohort of people living with HIV in Rio de Janeiro, Brazil, 2004-2015: a persisting problem[J]. BMC Infect Dis, 2022, 22(1): 475. DOI: 10.1186/s12879-022-07451-x. [6] Gesesew HA, Ward P, Woldemichael K, et al. Early mortality among children and adults in antiretroviral therapy programs in Southwest Ethiopia, 2003-15[J]. PLoS One, 2018, 13(6): e0198815. DOI: 10.1371/journal.pone.0198815. [7] Sobrino-Vegas P, Moreno S, Rubio R, et al. Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004-2013[J]. J Infect, 2016, 72(5): 587-596. DOI: 10.1016/j.jinf.2016.01.017. [8] Deeks SG, Phillips AN. HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity[J]. BMJ, 2009, 338: a3172. DOI: 10.1136/bmj.a3172. [9] Smith CJ, Ryom L, Weber R, et al. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D: A: D): a multicohort collaboration[J]. Lancet, 2014, 384(9939): 241-248. DOI: 10.1016/S0140-6736(14)60604-8. [10] 中国疾病预防控制中心性病艾滋病预防控制中心. 国家免费艾滋病抗病毒药物治疗手册[M]. 北京: 人民卫生出版社, 2016: 3.National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention. National manual for free antiretroviral therapy for AIDS[M]. Beijing: People's Medical Publishing House, 2016: 3. [11] 中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防控制中心. 中国艾滋病诊疗指南(2021年版)[J]. 中国艾滋病性病, 2021, 27(11): 1182-1201. DOI: 10.13419/j.cnki.aids.2021.11.02.Chinese Medical Association Infectious Diseases Branch AIDS and Hepatitis C Group, Chinese Center for Disease Control and Prevention. China guide on AIDS diagnosis and treatment (2021. edition)[J]. Chin J AIDS STD, 2021, 27(11): 1182-1201. DOI: 10.13419/j.cnki.aids.2021.11.02. [12] INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection[J]. N Engl J Med, 2015, 373(9): 795-807. DOI: 10.1056/NEJMoa1506816. [13] 安靓, 楼金成, 杨根, 等. HIV确诊后尽早启动治疗可能减少患者脱失[J]. 中华疾病控制杂志, 2020, 24(12): 1412-1417. DOI: 10.16462/j.cnki.zhjbkz.2020.12.010.An J, Lou JC, Yang G, et al. Early treatment initiation post-HIV diagnosis may reduce care dropoutn[J]. Chin J Dis Control Prev, 2020, 24(12): 1412-1417. DOI: 10.16462/j.cnki.zhjbkz.2020.12.010. [14] Collaborative Group on AIDS Incubation and HIV Survival. Time from HIV-1 seroconversion to AIDS and death before widespread use of highly-active antiretroviral therapy: a collaborative re-analysis[J]. Lancet, 2000, 355(9210): 1131-1137. [15] 储琴书, 梁佳佳, 韦陶, 等. 柳州市2005-2020年新发HIV感染者疾病进展及其影响因素[J]. 中华疾病控制杂志, 2022, 26(4): 386-391. DOI: 10.16462/j.cnki.zhjbkz.2022.04.004.Chu QS, Liang JJ, Wei T, et al. Disease progression and influencing factors of newly HIV-infected patients in Liuzhou City from 2005 to 2020[J]. Chin J Dis Control Prev, 2022, 26(4): 386-391. DOI: 10.16462/j.cnki.zhjbkz.2022.04.004. [16] Zhu J, Yousuf MA, Yang W, et al. Mortality and attrition rates within the first year of antiretroviral therapy initiation among people living with HIV in Guangxi, China: an observational cohort study[J]. Biomed Res Int, 2021, 2021: 6657112. DOI: 10.1155/2021/6657112. -
