Association of syndemic unhealthy alcohol use, cigarette use, and depression with all-cause mortality among adults living with and without HIV infection: Veterans aging cohort study

Natalie E. Chichetto, Suman Kundu, Matt S. Freiberg, Adeel A. Butt, Stephen Crystal, Kaku A. So-Armah, Robert L. Cook, R. Scott Braithwaite, David A. Fiellin, Maria R. Khan, Kendall J. Bryant, Julie R. Gaither, Shirish S. Barve, Kristina Crothers, Roger J. Bedimo, Alberta L. Warner, Hilary A. Tindle

Research output: Contribution to journalArticle

Abstract

Background. The prevalence and risk of concurrent unhealthy drinking, cigarette use, and depression on mortality among persons living with HIV (PLWH) is unclear. This study applied a syndemic framework to assess whether these co-occurring conditions increase mortality and whether such risk is differential by HIV status. Methods. We evaluated 6721 participants (49.8% PLWH) without baseline cancer from the Veterans Aging Cohort Study, a prospective, observational cohort of PLWH and matched uninfected veterans enrolled in 2002 and followed through 2015. Multivariable Cox proportional hazards regressions estimated risk of a syndemic score (number of conditions: that is, unhealthy drinking, cigarette use, and depressive symptoms) on all-cause mortality by HIV status, adjusting for demographic, health status, and HIV-related factors. Results. Fewer than 10% of participants had no conditions; 25.6% had 1, 51.0% had 2, and 15.0% had all 3. There were 1747 deaths (61.9% PLWH) during the median follow-up (11.4 years). Overall, age-adjusted mortality rates/1000 person-years increased with a greater number of conditions: (0: 12.0; 1: 21.2; 2: 30.4; 3: 36.3). For 3 conditions, the adjusted hazard ratio of mortality was 36% higher among PLWH compared with uninfected participants with 3 conditions (95% confidence interval, 1.07-1.72; P = .013), after adjusting for health status and HIV disease progression. Among PLWH and uninfected participants, mortality risk persisted after adjustment for time-updated health status. Conclusions. Syndemic unhealthy drinking, cigarette use, and depression are common and are associated with higher mortality risk among PLWH, underscoring the need to screen for and treat these conditions.

Original languageEnglish (US)
Article numberofz188
JournalOpen Forum Infectious Diseases
Volume6
Issue number6
DOIs
StatePublished - Jun 3 2019

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Veterans
Tobacco Products
HIV Infections
Cohort Studies
Alcohols
HIV
Depression
Mortality
Health Status
Drinking
Disease Progression
Demography
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Oncology

Keywords

  • Alcohol
  • Depression
  • HIV
  • Mortality
  • Smoking

Cite this

Chichetto, Natalie E. ; Kundu, Suman ; Freiberg, Matt S. ; Butt, Adeel A. ; Crystal, Stephen ; So-Armah, Kaku A. ; Cook, Robert L. ; Scott Braithwaite, R. ; Fiellin, David A. ; Khan, Maria R. ; Bryant, Kendall J. ; Gaither, Julie R. ; Barve, Shirish S. ; Crothers, Kristina ; Bedimo, Roger J. ; Warner, Alberta L. ; Tindle, Hilary A. / Association of syndemic unhealthy alcohol use, cigarette use, and depression with all-cause mortality among adults living with and without HIV infection : Veterans aging cohort study. In: Open Forum Infectious Diseases. 2019 ; Vol. 6, No. 6.
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title = "Association of syndemic unhealthy alcohol use, cigarette use, and depression with all-cause mortality among adults living with and without HIV infection: Veterans aging cohort study",
abstract = "Background. The prevalence and risk of concurrent unhealthy drinking, cigarette use, and depression on mortality among persons living with HIV (PLWH) is unclear. This study applied a syndemic framework to assess whether these co-occurring conditions increase mortality and whether such risk is differential by HIV status. Methods. We evaluated 6721 participants (49.8{\%} PLWH) without baseline cancer from the Veterans Aging Cohort Study, a prospective, observational cohort of PLWH and matched uninfected veterans enrolled in 2002 and followed through 2015. Multivariable Cox proportional hazards regressions estimated risk of a syndemic score (number of conditions: that is, unhealthy drinking, cigarette use, and depressive symptoms) on all-cause mortality by HIV status, adjusting for demographic, health status, and HIV-related factors. Results. Fewer than 10{\%} of participants had no conditions; 25.6{\%} had 1, 51.0{\%} had 2, and 15.0{\%} had all 3. There were 1747 deaths (61.9{\%} PLWH) during the median follow-up (11.4 years). Overall, age-adjusted mortality rates/1000 person-years increased with a greater number of conditions: (0: 12.0; 1: 21.2; 2: 30.4; 3: 36.3). For 3 conditions, the adjusted hazard ratio of mortality was 36{\%} higher among PLWH compared with uninfected participants with 3 conditions (95{\%} confidence interval, 1.07-1.72; P = .013), after adjusting for health status and HIV disease progression. Among PLWH and uninfected participants, mortality risk persisted after adjustment for time-updated health status. Conclusions. Syndemic unhealthy drinking, cigarette use, and depression are common and are associated with higher mortality risk among PLWH, underscoring the need to screen for and treat these conditions.",
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Chichetto, NE, Kundu, S, Freiberg, MS, Butt, AA, Crystal, S, So-Armah, KA, Cook, RL, Scott Braithwaite, R, Fiellin, DA, Khan, MR, Bryant, KJ, Gaither, JR, Barve, SS, Crothers, K, Bedimo, RJ, Warner, AL & Tindle, HA 2019, 'Association of syndemic unhealthy alcohol use, cigarette use, and depression with all-cause mortality among adults living with and without HIV infection: Veterans aging cohort study', Open Forum Infectious Diseases, vol. 6, no. 6, ofz188. https://doi.org/10.1093/ofid/ofz188

Association of syndemic unhealthy alcohol use, cigarette use, and depression with all-cause mortality among adults living with and without HIV infection : Veterans aging cohort study. / Chichetto, Natalie E.; Kundu, Suman; Freiberg, Matt S.; Butt, Adeel A.; Crystal, Stephen; So-Armah, Kaku A.; Cook, Robert L.; Scott Braithwaite, R.; Fiellin, David A.; Khan, Maria R.; Bryant, Kendall J.; Gaither, Julie R.; Barve, Shirish S.; Crothers, Kristina; Bedimo, Roger J.; Warner, Alberta L.; Tindle, Hilary A.

In: Open Forum Infectious Diseases, Vol. 6, No. 6, ofz188, 03.06.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of syndemic unhealthy alcohol use, cigarette use, and depression with all-cause mortality among adults living with and without HIV infection

T2 - Veterans aging cohort study

AU - Chichetto, Natalie E.

AU - Kundu, Suman

AU - Freiberg, Matt S.

AU - Butt, Adeel A.

AU - Crystal, Stephen

AU - So-Armah, Kaku A.

AU - Cook, Robert L.

AU - Scott Braithwaite, R.

AU - Fiellin, David A.

AU - Khan, Maria R.

AU - Bryant, Kendall J.

AU - Gaither, Julie R.

AU - Barve, Shirish S.

AU - Crothers, Kristina

AU - Bedimo, Roger J.

AU - Warner, Alberta L.

AU - Tindle, Hilary A.

PY - 2019/6/3

Y1 - 2019/6/3

N2 - Background. The prevalence and risk of concurrent unhealthy drinking, cigarette use, and depression on mortality among persons living with HIV (PLWH) is unclear. This study applied a syndemic framework to assess whether these co-occurring conditions increase mortality and whether such risk is differential by HIV status. Methods. We evaluated 6721 participants (49.8% PLWH) without baseline cancer from the Veterans Aging Cohort Study, a prospective, observational cohort of PLWH and matched uninfected veterans enrolled in 2002 and followed through 2015. Multivariable Cox proportional hazards regressions estimated risk of a syndemic score (number of conditions: that is, unhealthy drinking, cigarette use, and depressive symptoms) on all-cause mortality by HIV status, adjusting for demographic, health status, and HIV-related factors. Results. Fewer than 10% of participants had no conditions; 25.6% had 1, 51.0% had 2, and 15.0% had all 3. There were 1747 deaths (61.9% PLWH) during the median follow-up (11.4 years). Overall, age-adjusted mortality rates/1000 person-years increased with a greater number of conditions: (0: 12.0; 1: 21.2; 2: 30.4; 3: 36.3). For 3 conditions, the adjusted hazard ratio of mortality was 36% higher among PLWH compared with uninfected participants with 3 conditions (95% confidence interval, 1.07-1.72; P = .013), after adjusting for health status and HIV disease progression. Among PLWH and uninfected participants, mortality risk persisted after adjustment for time-updated health status. Conclusions. Syndemic unhealthy drinking, cigarette use, and depression are common and are associated with higher mortality risk among PLWH, underscoring the need to screen for and treat these conditions.

AB - Background. The prevalence and risk of concurrent unhealthy drinking, cigarette use, and depression on mortality among persons living with HIV (PLWH) is unclear. This study applied a syndemic framework to assess whether these co-occurring conditions increase mortality and whether such risk is differential by HIV status. Methods. We evaluated 6721 participants (49.8% PLWH) without baseline cancer from the Veterans Aging Cohort Study, a prospective, observational cohort of PLWH and matched uninfected veterans enrolled in 2002 and followed through 2015. Multivariable Cox proportional hazards regressions estimated risk of a syndemic score (number of conditions: that is, unhealthy drinking, cigarette use, and depressive symptoms) on all-cause mortality by HIV status, adjusting for demographic, health status, and HIV-related factors. Results. Fewer than 10% of participants had no conditions; 25.6% had 1, 51.0% had 2, and 15.0% had all 3. There were 1747 deaths (61.9% PLWH) during the median follow-up (11.4 years). Overall, age-adjusted mortality rates/1000 person-years increased with a greater number of conditions: (0: 12.0; 1: 21.2; 2: 30.4; 3: 36.3). For 3 conditions, the adjusted hazard ratio of mortality was 36% higher among PLWH compared with uninfected participants with 3 conditions (95% confidence interval, 1.07-1.72; P = .013), after adjusting for health status and HIV disease progression. Among PLWH and uninfected participants, mortality risk persisted after adjustment for time-updated health status. Conclusions. Syndemic unhealthy drinking, cigarette use, and depression are common and are associated with higher mortality risk among PLWH, underscoring the need to screen for and treat these conditions.

KW - Alcohol

KW - Depression

KW - HIV

KW - Mortality

KW - Smoking

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U2 - https://doi.org/10.1093/ofid/ofz188

DO - https://doi.org/10.1093/ofid/ofz188

M3 - Article

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JF - Open Forum Infectious Diseases

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