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dc.contributor.authorKisa, Adnan
dc.contributor.authorHay, Simon I.
dc.contributor.authorDwyer-Lindgren, Laura
dc.contributor.authorCork, Michael A
dc.contributor.authorHenry, Nathaniel J.
dc.contributor.authorWatson, Stefanie
dc.contributor.authorKisa, Sezer
dc.contributor.authorHIV Collaborators, Local Burden of Disease
dc.contributor.authorCroneberger, Andrew J
dc.contributor.authorBaumann, Mathew
dc.contributor.authorYang, Mingyou
dc.contributor.authorSerfes, Audrey L
dc.date.accessioned2021-01-10T14:57:39Z
dc.date.accessioned2021-02-23T13:38:01Z
dc.date.available2021-01-10T14:57:39Z
dc.date.available2021-02-23T13:38:01Z
dc.date.issued2021-01-08
dc.identifier.citationKisa A, Hay SI, Dwyer-Lindgren L, Cork, Henry NJ, Watson S, Kisa S, HIV Collaborators, Croneberger, Baumann, Yang, Serfes. Mapping subnational HIV mortality in sixLatin American countries with incompletevital registration systems. BMC Medicine. 2021;19(4)en
dc.identifier.issn1741-7015
dc.identifier.urihttps://hdl.handle.net/10642/9695
dc.description.abstractBackground: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.en
dc.description.sponsorshipThis work was primarily supported by grant OPP1132415 from the Bill & Melinda Gates Foundation.en
dc.language.isoenen
dc.publisherBMCen
dc.relation.ispartofseriesBMC Medicine;19, Article number: 4 (2021)
dc.rightsCreative Commons Attribution 4.0 International (CC BY 4.0) Licenseen
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectHIV/AIDSen
dc.subjectLatin Americaen
dc.subjectHIV mortalitiesen
dc.subjectVital registrationsen
dc.subjectSmall area estimationsen
dc.subjectMappingen
dc.titleMapping subnational HIV mortality in sixLatin American countries with incompletevital registration systemsen
dc.typeJournal articleen
dc.typePeer revieweden
dc.date.updated2021-01-10T14:57:39Z
dc.description.versionpublishedVersionen
dc.identifier.doihttps://doi.org/10.1186/s12916-020-01876-4
dc.identifier.cristin1868343
dc.source.journalBMC Medicine


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