Abstract P185: Disparities in Cardiovascular Disease and HIV Related Mortality in the United States
Authors: Ibrahim Ramzi , Singh Vikram J , Ravi Soumiya , Singh Simar J , Alabagi Abdulla , Habib Adam , Ferng Jonathan , Khludenev George , Salih Mohammed , Lee Justin Z 
Published: March 2023

Introduction:
Great strides have been made in microbiology and infectious diseases regarding HIV, revolutionizing the disease course. In the last forty years, advances in combination antiretroviral therapy (ART) have allowed HIV to become a chronic disease by dramatically decreasing the rates of acquired AIDS-defining illnesses. In contrast, a significant proportion of deaths in individuals infected with HIV due to cardiovascular events have been noted.

Hypothesis:
Disproportionate trends exist regarding CVD-related death within subpopulations of individuals infected with HIV in the United States (US).

Methods:
We utilized the CDC Wide-ranging Online Data for Epidemiologic Research database to ascertain mortality data using death certificate information from the National Vital Statistics System. All CVD-related deaths (ICD10 Codes: I00-I78) as the underlying cause of death and HIV (ICD10 Code: B20-B24) as the multiple causes of death from 1999 to 2020 were queried. The underlying cause of death is defined as the disease that directly led to death and multiple causes of death were defined as the diseases that contributed to death. Data were represented as age-adjusted mortality rates (AAMR) per 100,000 population and 95% confidence intervals, stratified by gender, racial, and geographic subgroups. Joinpoint regression (National Cancer Institute) was utilized for trend analysis and average annual percentage change (AAPC) calculation.

Results:
A total of 8,950 deaths were observed from 1999 to 2020. AAMR increased from 0.10 in 1999 to 0.15 in 2020 (p <0.05). AAMR was more likely to be related to non-ischemic heart disease (0.06) compared to ischemic heart disease (0.05) (p <0.05). AAMR was higher in males (0.20) compared with females (0.05) (p <0.05). AAMR was disproportionately higher in Black populations (0.53) compared to White populations (0.08) (p <0.05). No differences were observed for AAMR between Hispanic (0.12) and non-Hispanic (0.12) populations (p >0.05). AAMR was highest in the Northeast (0.15) and South (0.16) regions, followed by Western (0.11) regions, then finally the Midwest (0.06) regions (p <0.05). Cumulative AAPC from 1999 to 2020 was calculated at +1.7% (p <0.05) with a significant inflection point in 2010. AAPC increased significantly among male subgroups (+1.5%), Black subgroups (+0.8%), White subgroups (+1.6%), metro regions (+1.7%), Midwest regions (+2.3%), and Southern regions (+2.1%) (p <0.05), however, AAPC was not significantly different among female subgroups, Hispanic and non-Hispanic populations, non-metro regions, Northeast regions, and Western regions (p >0.05).

Conclusion:
Disparities linked to CVD-related death in the population infected with HIV exist among various gender, racial, and geographic subgroups. Research targeted at CVD prevention and management in this population is tantamount to addressing these healthcare disparities.