云南省玉溪市HIV/AIDS死亡者中确证后1年内死亡比例及相关因素分析

董文斌; 李世福; 赵金仙; 陈黎跃; 蔡英; 许杰; 刘小春; 李再友; 鲁建波; 李顺祥

doi:10.11847/zgggws1117107

云南省玉溪市HIV/AIDS死亡者中确证后1年内死亡比例及相关因素分析

Mortality and its influencing factors among HIV/AIDS patients within one year of confirmed diagnosis in Yuxi municipality, Yunnan province: 1995 – 2016

摘要

摘要:
目的探索人免疫缺陷病毒感染者/获得性免疫缺陷综合征（HIV/AIDS）死亡者中在确证后1年内死亡情况及其相关因素。
方法收集云南省玉溪市1995 — 2016年HIV/AIDS死亡者的死亡时间、死因及相关医疗信息，采用CoDe编码系统归类，应用logistic回归模型分析确证后1年内死亡影响因素。
结果 888例死亡，死因以机会性感染居首位(35.47 %，315/888)，其次以吸毒过量、心脑血管疾病、意外事故、非艾滋病相关性肿瘤为主。多因素logistic回归分析发现：确证时年龄越大（OR > 1，P < 0.05）、性传播（OR = 1.907，95 % CI = 1.174～3.096）、来源于医疗机构（OR = 8.494，95 % CI = 3.463～20.834）和自愿咨询（OR = 5.412，95 % CI = 2.112～13.870）、最近1次CD4⁺T值≤200 个/μL（OR = 4.189，95 % CI = 1.352～12.981）和未做CD4⁺T检测（OR = 2.527，95 % CI = 1.007～6.344）、未得到关怀救助（OR = 4.935，95 % CI = 2.991～8.143），未做抗病毒治疗（HAART）（OR = 2.521，95 % CI = 1.573～4.040）更容易在确证后1年内死亡；死因为机会性感染（OR = 5.128，95 % CI = 1.965～13.383）、艾滋病相关肿瘤（OR = 7.610，95 % CI = 1.535～37.731）、非艾滋病相关肿瘤（OR = 4.184，95 % CI = 1.312～13.383）在确证后1年内死亡的风险较高。死亡者中死于确证后1年内的占比由1999 — 2007年的49.34 %下降到2014 — 2016年的39.74 %。
结论历年死亡者中死于确证后1年内的占比逐年下降，HIV/AIDS死亡者在1年内死亡受多种因素影响，需针对性降低确证后1年内死亡风险，提高生存质量。

Abstract:
Objective To examine the mortality and its influencing factors among acquired immune deficiency syndrome/ human immunodeficiency virus (HIV/AIDS) patients within one year of confirmed diagnosis.
Methods Data on HIV/AIDS patients dead between 1999 and 2016 and with the registered permanent residence in Yuxi municipality of Yunnan province were extracted form National Comprehensive Information System for AIDS Control and Prevention. The specific causes of the HIV/AIDS deaths were classified based on the Coding Causes of Death in HIV (CoDe) Project. Multivariate logistic regression was used to analyze the factors associated with the deaths.
Results Of the 888 deaths identified, 315 (35.47%) died from opportunistic infections and others from non-AIDS related diseases, including drug overdose, cardiovascular and cerebrovascular diseases, accident, and non-AIDS related malignancy. Multivariate logistic regression analyses indicated that the patients with following characteristics were more likely to die within one year of the confirmed diagnosis: at older age at the diagnosis (odds ratio OR > 1 for all age groups compared to at the ages of 15 – 29 years, P < 0.05 for all), being infected through sexual transmission (OR = 1.907, 95% confidence interval 95% CI: 1.174 – 3.096), being diagnosed with HIV infection in hospitals (OR = 8.494, 95% CI: 3.463 – 20.834) or in voluntary counseling and testing clinics (OR = 5.412, 95% CI: 2.112 – 13.870), with the CD4⁺T cell count of less than 200 cell/μL at the last detection (OR = 4.189, 95% CI: 1.352 – 12.981) and not having any CD4⁺T cell count test (OR = 2.527, 95% CI: 1.007 – 6.344), without subsidized care (OR = 2.521, 95% CI: 1.573 – 4.040), and not receiving anti-retroviral therapy (ART) (OR = 2.521, 95% CI: 1.573 – 4.040). The results of multivariate logistic regression analysis also revealed that the patients died of opportunistic infection, AIDS-related malignancy, and non-AIDS-related malignancy were at higher risk of being died within one year of the confirmed diagnosis, with the OR (95% CI) of 5.128 (1.965 – 13.383), 7.610 (1.535 – 37.731), and 4.184 (1.312 – 13.383), respectively. The proportion of the patients being died within one year of the confirmed diagnosis decreased from 49.34% for the period from 1999 and 2007 to 39.74% between 2014 and 2016.
Conclusion The proportion of HIV/AIDS patients being died within one year of the confirmed diagnosis decreased yearly and the patients′ deaths were affect by multivariate factors in Yuxi municipality. The results suggest that specific interventions should be carried out to decrease the risk of death in the patients.

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