A cross-sectional, population-based study measuring comorbidity among people living with HIV in Ontario
1 C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St., Annex E., Ottawa, ON K1N 5C8, Canada
2 Department of Family Medicine, University of Ottawa, 43 Bruyère St., Floor 3JB, Ottawa, ON K1N 5C8, Canada
3 Department of Epidemiology, Biostatistics, and Occupational Health, McGill, 1020 Pine Ave. West, Montreal, QC, Canada
4 Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Rd., Room 3105, Ottawa, ON K1H 8M5, Canada
5 Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON, Canada
6 Department of Family and Community Medicine, University of Toronto, 500 University Ave., Toronto, ON, Canada
7 Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Room G1-06, Toronto, ON M4N 3M5, Canada
BMC Public Health 2014, 14:161 doi:10.1186/1471-2458-14-161Published: 13 February 2014
As people diagnosed with HIV and receiving combination antiretroviral therapy are now living longer, they are likely to acquire chronic conditions related to normal ageing and the effects of HIV and its treatment. Comordidities for people with HIV have not previously been described from a representative population perspective.
We used linked health administrative data from Ontario, Canada. We applied a validated algorithm to identify people with HIV among all residents aged 18 years or older between April 1, 1992 and March 31, 2009. We randomly selected 5 Ontario adults who were not identified with HIV for each person with HIV for comparison. Previously validated case definitions were used to identify persons with mental health disorders and any of the following physical chronic diseases: diabetes, congestive heart failure, acute myocardial infarction, stroke, hypertension, asthma, chronic obstructive lung disease, peripheral vascular disease and end-stage renal failure. We examined multimorbidity prevalence as the presence of at least two physical chronic conditions, or as combined physical-mental health multimorbidity. Direct age-sex standardized rates were calculated for both cohorts for comparison.
34.4% (95% confidence interval (CI) 33.6% to 35.2%) of people with HIV had at least one other physical condition. Prevalence was especially high for mental health conditions (38.6%), hypertension (14.9%) and asthma (12.7%). After accounting for age and sex differences, people with HIV had significantly higher prevalence of all chronic conditions except myocardial infarction and hypertension, as well as substantially higher multimorbidity (prevalence ratio 1.30, 95% CI 1.18 to 1.44) and combined physical-mental health multimorbidity (1.79, 95% CI 1.65 to 1.94). Prevalence of multimorbidity among people with HIV increased with age. The difference in prevalence of multimorbidity between the two cohorts was more pronounced among women.
People living with HIV in Ontario, especially women, had higher prevalence of comorbidity and multimorbidity than the general population. Quantifying this morbidity at the population level can help inform healthcare delivery requirements for this complex population.