Demographic Factors and Trends Associated with Mortality After AIDS Diagnosis in Puerto Rico, 2000-2020

Background: Millions of people have died from AIDS-related illnesses since the start of the epidemic. The objective of this study is to determine the relationship between life years lost and demographic factors in the subset of individuals with advanced HIV disease, that is, those who have received a diagnosis of AIDS, in Puerto Rico from 2000 to 2020, and to evaluate trends in poverty, age, and number of diagnoses and deaths over this timeframe. Methods: We identified 3,624 individuals diagnosed with AIDS who received services under the Eligible Metropolitan Area (EMA) of San Juan, Puerto Rico, and correlated demographic factors with AIDS descriptive statistics using a retrospective cohort study design. We used socioeconomic characteristics to describe the population, estimated the life years lost (LYL) compared with the life expectancy of the general population of Puerto Rico at a given age as the null model, and evaluated the relationship of demographic variables with LYL, as well as trends in poverty and age/number of deaths/diagnoses over time. Results: More life years are lost with earlier AIDS onset, and there is also a relationship between LYL and the level of poverty and the documented mode of transmission. An individual diagnosed with AIDS has an average life expectancy between 5 and 8 years, when averaged across all ages. LYL were greater in AIDS patients with lower income across all age groups; as well as in association with perinatal transmission as compared with other potential modes of transmission. LYL was also significantly increased in those without insurance in the age bracket of 40-49 years. No relationship with LYL and gender was detected. Moreover, over the years included in the timeframe of this study, certain trends emerged: we observed a greater proportion of AIDS to HIV diagnoses over time; HIV/AIDS diagnoses and deaths occurred on average at a higher age; the number of diagnoses per year initially rose over time and then declined; while the number of deaths per year as well as the poverty level in those diagnosed with HIV/AIDS increased over time. Conclusions: This study demonstrates the continued recent impact of the HIV epidemic specifically on those with advanced disease (AIDS),and further reaffirms the importance of treatment and prevention as well as demographic and social determinants of health, including age, poverty level, insurance status, and lifestyle, highlighting the increasing impact of HIV/AIDS on those with greater levels of poverty.