Mortality Among Persons With HIV in the United States During the COVID-19 Pandemic: A Population-Level Analysis

Abstract

Background: Whether the COVID-19 pandemic has had a disproportionate impact on mortality among persons with diagnosed HIV (PWDH) in the United States is unclear. Through our macroscale analysis, we seek to better understand how the COVID-19 pandemic affected mortality among PWDH. Methods: We obtained mortality and population data for the years 2018–2020 from the National HIV Surveillance System for the US PWDH population and from publicly available data for the general population. We computed mortality rates and excess mortality for both the general and PWDH populations. Stratifications by age, race/ethnicity, and sex were considered. For each group, we determined whether the 2020 mortality rates and mortality risk ratio showed a statistically significant change from 2018 to 2019. Results: Approximately 1550 excess deaths occurred among PWDH in 2020, with Black, Hispanic/Latino, and PWDH aged 55 years and older comprising the majority of excess deaths. Mortality rates increased in 2020 from 2018–2019 across the general population in all groups. Among PWDH, mortality rates either increased or showed no statistically significant change. These increases were similar to, or smaller than, those observed in the general population, resulting in a 7.7% decrease in the mortality risk ratio between PWDH and the general population. Conclusions: While mortality rates among PWDH increased in 2020 relative to 2018–2019, the increases were smaller, or of similar magnitude, to those observed in the general population. We thus do not find evidence of elevated mortality risk from the COVID-19 pandemic among PWDH. These findings held across subpopulations stratified by age, sex, and racial/ethnic group.