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Canadian Journal of Public Health

, Volume 108, Issue 2, pp e169–e175 | Cite as

Increased mortality among Indigenous persons in a multisite cohort of people living with HIV in Canada

  • Anita C. Benoit
  • Jaime Younger
  • Kerrigan Beaver
  • Randy Jackson
  • Mona Loutfy
  • Renée Masching
  • Tony Nobis
  • Earl Nowgesic
  • Doe O’Brien-Teengs
  • Wanda Whitebird
  • Art Zoccole
  • Mark Hull
  • Denise Jaworsky
  • Elizabeth Benson
  • Anita Rachlis
  • Sean B. Rourke
  • Ann N. Burchell
  • Curtis Cooper
  • Robert S. Hogg
  • Marina B. Klein
  • Nima Machouf
  • Julio S. G. Montaner
  • Chris Tsoukas
  • Janet RaboudEmail author
  • Building Bridges
  • Canadian Observational Cohort Collaboration
Quantitative Research
  • 1 Downloads

Abstract

OBJECTIVE: Compare all-cause mortality between Indigenous participants and participants of other ethnicities living with HIV initiating combination antiretroviral therapy (cART) in an interprovincial multi-site cohort.

METHODS: The Canadian Observational Cohort is a collaboration of 8 cohorts of treatment-naïve persons with HIV initiating cART after January 1, 2000. Participants were followed from the cART initiation date until death or last viral load (VL) test date on or before December 31, 2012. Cox proportional hazard models were used to estimate the effect of ethnicity on time until death after adjusting for age, gender, injection drug use, being a man who has sex with men, hepatitis C, province of origin, baseline VL and CD4 count, year of cART initiation and class of antiretroviral medication.

RESULTS: The study sample consisted of 7080 participants (497 Indigenous, 2471 Caucasian, 787 African/Caribbean/Black (ACB), 629 other, and 2696 unknown ethnicity). Most Indigenous persons were from British Columbia (BC) (83%), with smaller numbers from Ontario (13%) and Québec (4%). During the study period, 714 (10%) participants died. The five-year survival probability was lower for Indigenous persons (0.77) than for Caucasian (0.94), ACB (0.98), other ethnicities (0.96) and unknown ethnicities (0.85) (p < 0.0001). In an adjusted proportional hazard model for which missing data were imputed, Indigenous persons were more likely to die than Caucasian participants (hazard ratio = 2.69, p < 0.0001).

CONCLUSION: The mortality rate for Indigenous persons was higher than for other ethnicities and is largely reflective of the BC population. Addressing treatment challenges and identifying HIV- and non-HIV-related causes for mortality among Indigenous persons is required to optimize their clinical management.

Key Words

Indigenous mortality HIV cohort study combination antiretroviral therapy 

Résumé

OBJECTIF: Comparer la mortalité toutes causes confondues de participants autochtones et de participants d’autres origines ethniques vivant avec le VIH ayant entrepris un traitement antirétroviral d’association (TARa) dans une cohorte interprovinciale multi-sites.

MÉTHODE: Le centre de recherche collaborative CANOC (Canadian HIV Observational Cohort Collaboration) est une collaboration impliquant 8 cohortes de patients atteints du VIH n’ayant jamais reçu de traitement qui ont amorcé un TARa après le 1er janvier 2000. Ces patients ont été suivis depuis la date de début de leur TARa jusqu’à leur décès ou à la date de la dernière mesure de leur charge virale, soit au plus tard le 31 décembre 2012. À l’aide de modèles à risques proportionnels de Cox, nous avons estimé l’effet de l’ethnicité sur la longévité après avoir tenu compte de l’âge, du sexe, de l’utilisation de drogues par injection, du fait d’être un homme ayant des relations sexuelles avec des hommes, de l’hépatite C, de la province d’origine, de la charge virale et de la numération des lymphocytes CD4 de référence, de l’année de début du TARa et de la classe d’antirétroviraux.

RÉSULTATS: L’échantillon de l’étude comprenait 7 080 participants (497 Autochtones, 2 471 Blancs, 787 personnes des communautés africaine, caribéenne et noire [ACN], 629 personnes d’autres origines ethniques, et 2 696 personnes d’ethnicité inconnue). La plupart des Autochtones venaient de la Colombie-Britannique (C.-B.) (83 %) et dans de moindres proportions de l’Ontario (13 %) et du Québec (4 %). Durant la période de l’étude, 714 participants (10 %) sont décédés. La probabilité de survie après cinq ans a été plus faible chez les Autochtones (0,77) que chez les Blancs (0,94), les participants des communautés ACN (0,98), les participants d’autres origines ethniques (0,96) et les participants d’ethnicité inconnue (0,85) (p < 0,0001). Avec un modèle à risques proportionnels ajusté pour lequel les données manquantes ont été imputées, les Autochtones ont été plus susceptibles de mourir que les Blancs (coefficient de danger = 2,69, p<0,0001).

CONCLUSION: Le taux de mortalité des Autochtones était plus élevé que celui des participants d’autres origines ethniques et reflète dans une large mesure la population de la C.-B. Il est nécessaire d’aborder les défis thérapeutiques et de déterminer les causes de mortalité liées et non liées au VIH chez les Autochtones pour optimiser leur prise en charge clinique.

Mots Clés

Autochtones mortalité VIH étude de cohorte traitement antirétroviral d’association 

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Copyright information

© The Canadian Public Health Association 2017

Authors and Affiliations

  • Anita C. Benoit
    • 1
    • 2
  • Jaime Younger
    • 2
    • 3
  • Kerrigan Beaver
    • 2
  • Randy Jackson
    • 2
    • 4
  • Mona Loutfy
    • 1
    • 2
    • 5
    • 6
  • Renée Masching
    • 2
    • 7
  • Tony Nobis
    • 2
    • 8
  • Earl Nowgesic
    • 2
    • 9
  • Doe O’Brien-Teengs
    • 2
    • 10
  • Wanda Whitebird
    • 2
    • 8
  • Art Zoccole
    • 2
    • 11
  • Mark Hull
    • 2
    • 12
    • 13
  • Denise Jaworsky
    • 2
    • 13
  • Elizabeth Benson
    • 2
    • 14
  • Anita Rachlis
    • 15
  • Sean B. Rourke
    • 16
    • 17
    • 18
    • 19
  • Ann N. Burchell
    • 9
    • 19
    • 20
  • Curtis Cooper
    • 21
  • Robert S. Hogg
    • 2
    • 12
    • 22
  • Marina B. Klein
    • 23
  • Nima Machouf
    • 24
  • Julio S. G. Montaner
    • 12
    • 13
  • Chris Tsoukas
    • 25
  • Janet Raboud
    • 2
    • 3
    • 9
    Email author
  • Building Bridges
  • Canadian Observational Cohort Collaboration
  1. 1.Women’s College Research InstituteWomen’s College HospitalTorontoCanada
  2. 2.Building Bridges TeamTorontoCanada
  3. 3.Toronto General Research InstituteUniversity Health NetworkTorontoCanada
  4. 4.McMaster UniversityHamiltonCanada
  5. 5.Maple Leaf Medical ClinicTorontoCanada
  6. 6.Department of MedicineUniversity of TorontoTorontoCanada
  7. 7.Canadian Aboriginal AIDS NetworkDartmouthCanada
  8. 8.Ontario Aboriginal HIV/AIDS StrategyTorontoCanada
  9. 9.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  10. 10.Lakehead UniversityThunder BayCanada
  11. 11.2-Spirited People of the 1st NationsTorontoCanada
  12. 12.British Columbia Centre for Excellence in HIV/AIDSVancouverCanada
  13. 13.Department of MedicineUniversity of British ColumbiaVancouverCanada
  14. 14.Gitxsan NationHazeltonCanada
  15. 15.Sunnybrook Health Sciences CentreTorontoCanada
  16. 16.Ontario HIV Treatment NetworkTorontoCanada
  17. 17.Department of PsychiatryUniversity of TorontoTorontoCanada
  18. 18.Department of PsychiatrySt. Michael’s HospitalTorontoCanada
  19. 19.Centre for Urban Health Solutions, Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  20. 20.Department of Family and Community Medicine, Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  21. 21.Ottawa Hospital Research InstituteOttawaCanada
  22. 22.Faculty of Health SciencesSimon Fraser UniversityVancouverCanada
  23. 23.Department of MedicineMcGill University Health Centre Research InstituteMontréalCanada
  24. 24.Clinique Médicale L’ActuelMontréalCanada
  25. 25.Faculty of MedicineMcGill University Health CentreMontréalCanada

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