Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Local Burden Dis HIV Collaborators; Michael A. Cork; Nathaniel J. Henry; Stefanie Watson; Andrew J. Croneberger; Mathew Baumann; Ian D. Letourneau; Mingyou Yang; Audrey L. Serfes; Jaffar Abbas; Nooshin Abbasi; Hedayat Abbastabar; Lucas G. Abreu; Eman Abu-Gharbieh; Basavaprabhu Achappa; Maryam Adabi; Tadele G. Adal; Adeyinka E. Adegbosin; Victor Adekanmbi; Olatunji O. Adetokunboh; Marcela Agudelo-Botero; Bright O. Ahinkorah; Keivan Ahmadi; Muktar B. Ahmed; Robert K. Alhassan; Vahid Alipour; Amir Almasi-Hashiani; Nelson Alvis-Guzman; Robert Ancuceanu; Tudorel Andrei; Davood Anvari; Muhammad Aqeel; Jalal Arabloo; Olatunde Aremu; Malke Asaad; Desta D. Atnafu; Alok Atreya; Beatriz Paulina Ayala Quintanilla; Samad Azari; B. B. Darshan; Atif A. Baig; Maciej Banach; Simachew A. Bante; Miguel A. Barboza; Sanjay Basu; Neeraj Bedi; Diana F. Bejarano Ramirez; Florian Fischer; Huong L. T. Nguyen; Maarten J. Postma; Zhi-Jiang Zhang

doi:10.1186/s12916-020-01876-4

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Local Burden Dis HIV Collaborators, Michael A. Cork, Nathaniel J. Henry, Stefanie Watson, Andrew J. Croneberger, Mathew Baumann, Ian D. Letourneau, Mingyou Yang, Audrey L. Serfes, Jaffar Abbas, Nooshin Abbasi, Hedayat Abbastabar, Lucas G. Abreu, Eman Abu-Gharbieh, Basavaprabhu Achappa, Maryam Adabi, Tadele G. Adal, Adeyinka E. Adegbosin, Victor Adekanmbi, Olatunji O. AdetokunbohMarcela Agudelo-Botero, Bright O. Ahinkorah, Keivan Ahmadi, Muktar B. Ahmed, Robert K. Alhassan, Vahid Alipour, Amir Almasi-Hashiani, Nelson Alvis-Guzman, Robert Ancuceanu, Tudorel Andrei, Davood Anvari, Muhammad Aqeel, Jalal Arabloo, Olatunde Aremu, Malke Asaad, Desta D. Atnafu, Alok Atreya, Beatriz Paulina Ayala Quintanilla, Samad Azari, B. B. Darshan, Atif A. Baig, Maciej Banach, Simachew A. Bante, Miguel A. Barboza, Sanjay Basu, Neeraj Bedi, Diana F. Bejarano Ramirez, Florian Fischer, Huong L. T. Nguyen, Maarten J. Postma, Zhi-Jiang Zhang

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Abstract

Background: 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 45years 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.

Original language	English
Article number	4
Number of pages	25
Journal	BMC Medicine
Volume	19
Issue number	1
DOIs	https://doi.org/10.1186/s12916-020-01876-4
Publication status	Published - 8-Jan-2021

Keywords

HIV
AIDS
Latin America
HIV mortality
Vital registration
Small area estimation
Mapping
Spatial statistics
ANTIRETROVIRAL THERAPY
GLOBAL BURDEN
LOW-INCOME
TRENDS
HIV/AIDS
SEX
HEALTH
BRAZIL
DEATH
TUBERCULOSIS

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Local Burden Dis HIV Collaborators, Cork, M. A., Henry, N. J., Watson, S., Croneberger, A. J., Baumann, M., Letourneau, I. D., Yang, M., Serfes, A. L., Abbas, J., Abbasi, N., Abbastabar, H., Abreu, L. G., Abu-Gharbieh, E., Achappa, B., Adabi, M., Adal, T. G., Adegbosin, A. E., Adekanmbi, V., ... Zhang, Z.-J. (2021). Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems. BMC Medicine, 19(1), Article 4. https://doi.org/10.1186/s12916-020-01876-4

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title = "Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems",

abstract = "Background: 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 45years 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.",

keywords = "HIV, AIDS, Latin America, HIV mortality, Vital registration, Small area estimation, Mapping, Spatial statistics, ANTIRETROVIRAL THERAPY, GLOBAL BURDEN, LOW-INCOME, TRENDS, HIV/AIDS, SEX, HEALTH, BRAZIL, DEATH, TUBERCULOSIS",

author = "{Local Burden Dis HIV Collaborators} and Cork, {Michael A.} and Henry, {Nathaniel J.} and Stefanie Watson and Croneberger, {Andrew J.} and Mathew Baumann and Letourneau, {Ian D.} and Mingyou Yang and Serfes, {Audrey L.} and Jaffar Abbas and Nooshin Abbasi and Hedayat Abbastabar and Abreu, {Lucas G.} and Eman Abu-Gharbieh and Basavaprabhu Achappa and Maryam Adabi and Adal, {Tadele G.} and Adegbosin, {Adeyinka E.} and Victor Adekanmbi and Adetokunboh, {Olatunji O.} and Marcela Agudelo-Botero and Ahinkorah, {Bright O.} and Keivan Ahmadi and Ahmed, {Muktar B.} and Alhassan, {Robert K.} and Vahid Alipour and Amir Almasi-Hashiani and Nelson Alvis-Guzman and Robert Ancuceanu and Tudorel Andrei and Davood Anvari and Muhammad Aqeel and Jalal Arabloo and Olatunde Aremu and Malke Asaad and Atnafu, {Desta D.} and Alok Atreya and Quintanilla, {Beatriz Paulina Ayala} and Samad Azari and Darshan, {B. B.} and Baig, {Atif A.} and Maciej Banach and Bante, {Simachew A.} and Barboza, {Miguel A.} and Sanjay Basu and Neeraj Bedi and {Bejarano Ramirez}, {Diana F.} and Florian Fischer and Nguyen, {Huong L. T.} and Postma, {Maarten J.} and Zhi-Jiang Zhang",

year = "2021",

month = jan,

day = "8",

doi = "10.1186/s12916-020-01876-4",

language = "English",

volume = "19",

journal = "BMC Medicine",

issn = "1741-7015",

publisher = "BMC",

number = "1",

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Local Burden Dis HIV Collaborators, Cork, MA, Henry, NJ, Watson, S, Croneberger, AJ, Baumann, M, Letourneau, ID, Yang, M, Serfes, AL, Abbas, J, Abbasi, N, Abbastabar, H, Abreu, LG, Abu-Gharbieh, E, Achappa, B, Adabi, M, Adal, TG, Adegbosin, AE, Adekanmbi, V, Adetokunboh, OO, Agudelo-Botero, M, Ahinkorah, BO, Ahmadi, K, Ahmed, MB, Alhassan, RK, Alipour, V, Almasi-Hashiani, A, Alvis-Guzman, N, Ancuceanu, R, Andrei, T, Anvari, D, Aqeel, M, Arabloo, J, Aremu, O, Asaad, M, Atnafu, DD, Atreya, A, Quintanilla, BPA, Azari, S, Darshan, BB, Baig, AA, Banach, M, Bante, SA, Barboza, MA, Basu, S, Bedi, N, Bejarano Ramirez, DF, Fischer, F, Nguyen, HLT, Postma, MJ & Zhang, Z-J 2021, 'Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems', BMC Medicine, vol. 19, no. 1, 4. https://doi.org/10.1186/s12916-020-01876-4

TY - JOUR

T1 - Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

AU - Local Burden Dis HIV Collaborators

AU - Cork, Michael A.

AU - Henry, Nathaniel J.

AU - Watson, Stefanie

AU - Croneberger, Andrew J.

AU - Baumann, Mathew

AU - Letourneau, Ian D.

AU - Yang, Mingyou

AU - Serfes, Audrey L.

AU - Abbas, Jaffar

AU - Abbasi, Nooshin

AU - Abbastabar, Hedayat

AU - Abreu, Lucas G.

AU - Abu-Gharbieh, Eman

AU - Achappa, Basavaprabhu

AU - Adabi, Maryam

AU - Adal, Tadele G.

AU - Adegbosin, Adeyinka E.

AU - Adekanmbi, Victor

AU - Adetokunboh, Olatunji O.

AU - Agudelo-Botero, Marcela

AU - Ahinkorah, Bright O.

AU - Ahmadi, Keivan

AU - Ahmed, Muktar B.

AU - Alhassan, Robert K.

AU - Alipour, Vahid

AU - Almasi-Hashiani, Amir

AU - Alvis-Guzman, Nelson

AU - Ancuceanu, Robert

AU - Andrei, Tudorel

AU - Anvari, Davood

AU - Aqeel, Muhammad

AU - Arabloo, Jalal

AU - Aremu, Olatunde

AU - Asaad, Malke

AU - Atnafu, Desta D.

AU - Atreya, Alok

AU - Quintanilla, Beatriz Paulina Ayala

AU - Azari, Samad

AU - Darshan, B. B.

AU - Baig, Atif A.

AU - Banach, Maciej

AU - Bante, Simachew A.

AU - Barboza, Miguel A.

AU - Basu, Sanjay

AU - Bedi, Neeraj

AU - Bejarano Ramirez, Diana F.

AU - Fischer, Florian

AU - Nguyen, Huong L. T.

AU - Postma, Maarten J.

AU - Zhang, Zhi-Jiang

PY - 2021/1/8

Y1 - 2021/1/8

N2 - Background: 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 45years 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.

AB - Background: 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 45years 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.

KW - HIV

KW - AIDS

KW - Latin America

KW - HIV mortality

KW - Vital registration

KW - Small area estimation

KW - Mapping

KW - Spatial statistics

KW - ANTIRETROVIRAL THERAPY

KW - GLOBAL BURDEN

KW - LOW-INCOME

KW - TRENDS

KW - HIV/AIDS

KW - SEX

KW - HEALTH

KW - BRAZIL

KW - DEATH

KW - TUBERCULOSIS

U2 - 10.1186/s12916-020-01876-4

DO - 10.1186/s12916-020-01876-4

M3 - Article

SN - 1741-7015

VL - 19

JO - BMC Medicine

JF - BMC Medicine

IS - 1

M1 - 4

ER -

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

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