Racial/ethnic differences in the association between alcohol use and mortality among men living with HIV

Kara M. Bensley, Kathleen A. McGinnis, David A. Fiellin, Adam J. Gordon, Kevin L. Kraemer, Kendall J. Bryant, E. Jennifer Edelman, Stephen Crystal, Julie R. Gaither, P. Todd Korthuis, Brandon D.L. Marshall, India J. Ornelas, K. C.Gary Chan, Julia C. Dombrowski, John C. Fortney, Amy C. Justice, Emily C. Williams

Research output: Contribution to journalArticle

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Abstract

Background: Increasing alcohol use is associated with increased risk of mortality among patients living with HIV (PLWH). This association varies by race/ethnicity among general outpatients, but racial/ethnic variation has not been investigated among PLWH, among whom racial/ethnic minorities are disproportionately represented. Methods: VA electronic health record data from the Veterans Aging Cohort Study (2008-2012) were used to describe and compare mortality rates across race/ethnicity and levels of alcohol use defined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. Within each racial/ethnic group, Cox proportional hazards models, adjusted for age, disease severity, and comorbidities, compared mortality risk for moderate-risk (AUDIT-C = 4-7) and high-risk (AUDIT-C ≥ 8) relative to lower-risk (AUDIT-C = 1-3) alcohol use. Results: Mean follow-up time among black (n = 8518), Hispanic (n = 1353), and white (n = 7368) male PLWH with documented AUDIT-C screening (n = 17,239) was 4.3 years. Black PLWH had the highest mortality rate among patients reporting lower-risk alcohol use (2.9/100 person-years) relative to Hispanic and white PLWH (1.8 and 2.3, respectively) (p value for overall comparison = 0.011). Mortality risk was increased for patients reporting high-risk relative to lower-risk alcohol use in all racial/ethnic groups [black adjusted hazard ratio (AHR) = 1.36, 95% confidence interval (CI) 1.12-1.66; Hispanic AHR = 2.18, 95% CI 1.30-3.64; and white AHR = 2.04, 95% CI 1.61-2.58]. For only white PLWH, mortality risk was increased for patients reporting moderate-relative to lower-risk alcohol use (black AHR = 1.09, 95% CI 0.93-1.27; Hispanic AHR = 1.36, 95% CI 0.89-2.09; white AHR = 1.51, 95% CI 1.28-1.77). Conclusion: Among all PLWH, mortality risk was increased among patients reporting high-risk alcohol use across all racial/ethnic groups, but mortality risk was only increased among patients reporting moderate-risk relative to lower-risk alcohol use among white PLWH, and black patients appeared to have higher mortality risk relative to white patients at lower-risk levels of alcohol use. Findings of the present study further underscore the need to address unhealthy alcohol use among PLWH, and future research is needed to understand mechanisms underlying observed differences.

Original languageEnglish (US)
Article number2
JournalAddiction Science and Clinical Practice
Volume13
Issue number1
DOIs
StatePublished - Dec 27 2018

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Alcohols
HIV
Mortality
Confidence Intervals
Hispanic Americans
Ethnic Groups
Electronic Health Records
Veterans
Proportional Hazards Models
Comorbidity
Cohort Studies
Outpatients

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Keywords

  • Alcohol use
  • HIV
  • Mortality risk
  • Racial/ethnic disparities
  • Veterans

Cite this

Bensley, K. M., McGinnis, K. A., Fiellin, D. A., Gordon, A. J., Kraemer, K. L., Bryant, K. J., ... Williams, E. C. (2018). Racial/ethnic differences in the association between alcohol use and mortality among men living with HIV. Addiction Science and Clinical Practice, 13(1), [2]. https://doi.org/10.1186/s13722-017-0103-z
Bensley, Kara M. ; McGinnis, Kathleen A. ; Fiellin, David A. ; Gordon, Adam J. ; Kraemer, Kevin L. ; Bryant, Kendall J. ; Edelman, E. Jennifer ; Crystal, Stephen ; Gaither, Julie R. ; Korthuis, P. Todd ; Marshall, Brandon D.L. ; Ornelas, India J. ; Chan, K. C.Gary ; Dombrowski, Julia C. ; Fortney, John C. ; Justice, Amy C. ; Williams, Emily C. / Racial/ethnic differences in the association between alcohol use and mortality among men living with HIV. In: Addiction Science and Clinical Practice. 2018 ; Vol. 13, No. 1.
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title = "Racial/ethnic differences in the association between alcohol use and mortality among men living with HIV",
abstract = "Background: Increasing alcohol use is associated with increased risk of mortality among patients living with HIV (PLWH). This association varies by race/ethnicity among general outpatients, but racial/ethnic variation has not been investigated among PLWH, among whom racial/ethnic minorities are disproportionately represented. Methods: VA electronic health record data from the Veterans Aging Cohort Study (2008-2012) were used to describe and compare mortality rates across race/ethnicity and levels of alcohol use defined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. Within each racial/ethnic group, Cox proportional hazards models, adjusted for age, disease severity, and comorbidities, compared mortality risk for moderate-risk (AUDIT-C = 4-7) and high-risk (AUDIT-C ≥ 8) relative to lower-risk (AUDIT-C = 1-3) alcohol use. Results: Mean follow-up time among black (n = 8518), Hispanic (n = 1353), and white (n = 7368) male PLWH with documented AUDIT-C screening (n = 17,239) was 4.3 years. Black PLWH had the highest mortality rate among patients reporting lower-risk alcohol use (2.9/100 person-years) relative to Hispanic and white PLWH (1.8 and 2.3, respectively) (p value for overall comparison = 0.011). Mortality risk was increased for patients reporting high-risk relative to lower-risk alcohol use in all racial/ethnic groups [black adjusted hazard ratio (AHR) = 1.36, 95{\%} confidence interval (CI) 1.12-1.66; Hispanic AHR = 2.18, 95{\%} CI 1.30-3.64; and white AHR = 2.04, 95{\%} CI 1.61-2.58]. For only white PLWH, mortality risk was increased for patients reporting moderate-relative to lower-risk alcohol use (black AHR = 1.09, 95{\%} CI 0.93-1.27; Hispanic AHR = 1.36, 95{\%} CI 0.89-2.09; white AHR = 1.51, 95{\%} CI 1.28-1.77). Conclusion: Among all PLWH, mortality risk was increased among patients reporting high-risk alcohol use across all racial/ethnic groups, but mortality risk was only increased among patients reporting moderate-risk relative to lower-risk alcohol use among white PLWH, and black patients appeared to have higher mortality risk relative to white patients at lower-risk levels of alcohol use. Findings of the present study further underscore the need to address unhealthy alcohol use among PLWH, and future research is needed to understand mechanisms underlying observed differences.",
keywords = "Alcohol use, HIV, Mortality risk, Racial/ethnic disparities, Veterans",
author = "Bensley, {Kara M.} and McGinnis, {Kathleen A.} and Fiellin, {David A.} and Gordon, {Adam J.} and Kraemer, {Kevin L.} and Bryant, {Kendall J.} and Edelman, {E. Jennifer} and Stephen Crystal and Gaither, {Julie R.} and Korthuis, {P. Todd} and Marshall, {Brandon D.L.} and Ornelas, {India J.} and Chan, {K. C.Gary} and Dombrowski, {Julia C.} and Fortney, {John C.} and Justice, {Amy C.} and Williams, {Emily C.}",
year = "2018",
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language = "English (US)",
volume = "13",
journal = "Addiction science & clinical practice",
issn = "1940-0632",
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Bensley, KM, McGinnis, KA, Fiellin, DA, Gordon, AJ, Kraemer, KL, Bryant, KJ, Edelman, EJ, Crystal, S, Gaither, JR, Korthuis, PT, Marshall, BDL, Ornelas, IJ, Chan, KCG, Dombrowski, JC, Fortney, JC, Justice, AC & Williams, EC 2018, 'Racial/ethnic differences in the association between alcohol use and mortality among men living with HIV', Addiction Science and Clinical Practice, vol. 13, no. 1, 2. https://doi.org/10.1186/s13722-017-0103-z

Racial/ethnic differences in the association between alcohol use and mortality among men living with HIV. / Bensley, Kara M.; McGinnis, Kathleen A.; Fiellin, David A.; Gordon, Adam J.; Kraemer, Kevin L.; Bryant, Kendall J.; Edelman, E. Jennifer; Crystal, Stephen; Gaither, Julie R.; Korthuis, P. Todd; Marshall, Brandon D.L.; Ornelas, India J.; Chan, K. C.Gary; Dombrowski, Julia C.; Fortney, John C.; Justice, Amy C.; Williams, Emily C.

In: Addiction Science and Clinical Practice, Vol. 13, No. 1, 2, 27.12.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Racial/ethnic differences in the association between alcohol use and mortality among men living with HIV

AU - Bensley, Kara M.

AU - McGinnis, Kathleen A.

AU - Fiellin, David A.

AU - Gordon, Adam J.

AU - Kraemer, Kevin L.

AU - Bryant, Kendall J.

AU - Edelman, E. Jennifer

AU - Crystal, Stephen

AU - Gaither, Julie R.

AU - Korthuis, P. Todd

AU - Marshall, Brandon D.L.

AU - Ornelas, India J.

AU - Chan, K. C.Gary

AU - Dombrowski, Julia C.

AU - Fortney, John C.

AU - Justice, Amy C.

AU - Williams, Emily C.

PY - 2018/12/27

Y1 - 2018/12/27

N2 - Background: Increasing alcohol use is associated with increased risk of mortality among patients living with HIV (PLWH). This association varies by race/ethnicity among general outpatients, but racial/ethnic variation has not been investigated among PLWH, among whom racial/ethnic minorities are disproportionately represented. Methods: VA electronic health record data from the Veterans Aging Cohort Study (2008-2012) were used to describe and compare mortality rates across race/ethnicity and levels of alcohol use defined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. Within each racial/ethnic group, Cox proportional hazards models, adjusted for age, disease severity, and comorbidities, compared mortality risk for moderate-risk (AUDIT-C = 4-7) and high-risk (AUDIT-C ≥ 8) relative to lower-risk (AUDIT-C = 1-3) alcohol use. Results: Mean follow-up time among black (n = 8518), Hispanic (n = 1353), and white (n = 7368) male PLWH with documented AUDIT-C screening (n = 17,239) was 4.3 years. Black PLWH had the highest mortality rate among patients reporting lower-risk alcohol use (2.9/100 person-years) relative to Hispanic and white PLWH (1.8 and 2.3, respectively) (p value for overall comparison = 0.011). Mortality risk was increased for patients reporting high-risk relative to lower-risk alcohol use in all racial/ethnic groups [black adjusted hazard ratio (AHR) = 1.36, 95% confidence interval (CI) 1.12-1.66; Hispanic AHR = 2.18, 95% CI 1.30-3.64; and white AHR = 2.04, 95% CI 1.61-2.58]. For only white PLWH, mortality risk was increased for patients reporting moderate-relative to lower-risk alcohol use (black AHR = 1.09, 95% CI 0.93-1.27; Hispanic AHR = 1.36, 95% CI 0.89-2.09; white AHR = 1.51, 95% CI 1.28-1.77). Conclusion: Among all PLWH, mortality risk was increased among patients reporting high-risk alcohol use across all racial/ethnic groups, but mortality risk was only increased among patients reporting moderate-risk relative to lower-risk alcohol use among white PLWH, and black patients appeared to have higher mortality risk relative to white patients at lower-risk levels of alcohol use. Findings of the present study further underscore the need to address unhealthy alcohol use among PLWH, and future research is needed to understand mechanisms underlying observed differences.

AB - Background: Increasing alcohol use is associated with increased risk of mortality among patients living with HIV (PLWH). This association varies by race/ethnicity among general outpatients, but racial/ethnic variation has not been investigated among PLWH, among whom racial/ethnic minorities are disproportionately represented. Methods: VA electronic health record data from the Veterans Aging Cohort Study (2008-2012) were used to describe and compare mortality rates across race/ethnicity and levels of alcohol use defined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. Within each racial/ethnic group, Cox proportional hazards models, adjusted for age, disease severity, and comorbidities, compared mortality risk for moderate-risk (AUDIT-C = 4-7) and high-risk (AUDIT-C ≥ 8) relative to lower-risk (AUDIT-C = 1-3) alcohol use. Results: Mean follow-up time among black (n = 8518), Hispanic (n = 1353), and white (n = 7368) male PLWH with documented AUDIT-C screening (n = 17,239) was 4.3 years. Black PLWH had the highest mortality rate among patients reporting lower-risk alcohol use (2.9/100 person-years) relative to Hispanic and white PLWH (1.8 and 2.3, respectively) (p value for overall comparison = 0.011). Mortality risk was increased for patients reporting high-risk relative to lower-risk alcohol use in all racial/ethnic groups [black adjusted hazard ratio (AHR) = 1.36, 95% confidence interval (CI) 1.12-1.66; Hispanic AHR = 2.18, 95% CI 1.30-3.64; and white AHR = 2.04, 95% CI 1.61-2.58]. For only white PLWH, mortality risk was increased for patients reporting moderate-relative to lower-risk alcohol use (black AHR = 1.09, 95% CI 0.93-1.27; Hispanic AHR = 1.36, 95% CI 0.89-2.09; white AHR = 1.51, 95% CI 1.28-1.77). Conclusion: Among all PLWH, mortality risk was increased among patients reporting high-risk alcohol use across all racial/ethnic groups, but mortality risk was only increased among patients reporting moderate-risk relative to lower-risk alcohol use among white PLWH, and black patients appeared to have higher mortality risk relative to white patients at lower-risk levels of alcohol use. Findings of the present study further underscore the need to address unhealthy alcohol use among PLWH, and future research is needed to understand mechanisms underlying observed differences.

KW - Alcohol use

KW - HIV

KW - Mortality risk

KW - Racial/ethnic disparities

KW - Veterans

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