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Nanditha, Ni Gusti Ayu

University of British Columbia

Background: The complex process of aging with HIV presents unique challenges, manifested, among others, as an increased risk of chronic comorbidities and, in turn, poor health outcomes among people living with HIV (PLWH). Utilizing large-scale administrative health data, this dissertation aimed to comprehensively examine, at the population-level, the burden of nine common chronic comorbidities as an indicator of aging among PLWH compared to age-sex-matched HIV-negative controls in British Columbia, Canada. This dissertation sought to develop a methodology to improve the reliability of prevalence and incidence estimates produced from administrative data research. Methods: Longitudinal individual-level data were obtained from linked provincial datasets established for Comparative Outcomes And Service Utilization Trends Study, a population-based cohort. We first assessed the critical but understudied impact of lookback windows (LWs), a retrospective period to ascertain diagnoses within administrative data, on prevalence and incidence of chronic comorbidities. Among PLWH and HIV-negative controls, we then examined various measures of disease burden during 2001-2012: annual prevalence trends and age at diagnosis of different comorbidities, multimorbidity and associated mortality, and disability-adjusted life years (DALYs), a measure of disease burden considering both mortality and morbidity. Results: The impact of LWs was comorbidity- and population-specific, with shorter LWs resulting in higher misclassification of prevalent and incidence cases. Compared to HIV-negative controls, for most comorbidities, PLWH experienced elevated prevalence, up to 10 times higher for liver diseases, and earlier age at diagnosis, up to 12.5 years earlier for non-HIV-related dementia. Prevalence of multimorbidity was double among PLWH, with those from rural regions experiencing higher excess associated mortality. Driven by premature mortality due to non-AIDS-defining cancers, PLWH also experienced twofold higher DALYs associated with chronic comorbidities. Conclusions: This dissertation contributes population-level evidence on the disproportionate burden of chronic comorbidities experienced by PLWH as they age. As aging shapes healthcare needs, our findings support optimized screening for comorbidities at earlier ages among PLWH and an HIV care model that integrates prevention and treatment of chronic comorbidities. Additionally, data-driven approaches proposed in this dissertation, which inform LW choices and address concerns on the growing use of administrative data for research, are reproducible to other settings.

Text

2022-08-29

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/82581

Experimental Medicine

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/