Estimating Excess Mortality Among People Living with HIV/AIDS During the COVID-19 Pandemic in the USA
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Objective(s)
To quantify the all-cause excess death rate of people living with HIV/AIDS (PWHA) during the 2020-2022 COVID-19 pandemic in the United States (U.S.), including stratifications by sex, age, race/ethnicity, and region.
Methods
Using publicly available data from the CDC NCHHSTP AtlasPlus dashboard, we employed the ensemble n-subepidemic modeling framework ( SubEpiPredict toolbox). This flexible modeling framework offers enhanced precision over static historical-average methods and was used to generate forecasts of U.S. deaths among PWHA for 2020-2022. The models were calibrated using 12 years of pre-pandemic data (2008-2019), with the median excess death rate calculated as the difference between forecasted and observed death rates. Results were stratified by age, sex, race/ethnicity, and U.S. region.
Results
Overall excess deaths among PWHA are estimated at 7,783 [95% Prediction Interval (PI) 5,098-10,525] crude excess deaths, or a rate of 2.77 [95% PI 1.81-3.75] excess deaths per 100,000 people, peaking in 2021. Excess death rates were highest among the following categories: Males (3.39), age group 55-64 (4.94), Multiracial (12.82), and in the Northeast U.S. region (4.12). The absolute number of excess deaths was highest among the following categories: Males (4,692), age group 65+ (2,560), Black/African Americans (3,969), and among those in the South U.S. region (4,025).
Conclusions
These systematic, model-based results reveal stark heterogeneities among PWHA by exposing recent mortality patterns that may not be captured by disease-specific mortality reporting alone. These heterogeneous findings can inform future public health programming and resource allocation and support tailored interventions for vulnerable populations.
