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Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2018

Open Access 01-12-2018 | Research

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

Authors: 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

Published in: Addiction Science & Clinical Practice | Issue 1/2018

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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.
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Metadata
Title
Racial/ethnic differences in the association between alcohol use and mortality among men living with HIV
Authors
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
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2018
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-017-0103-z

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