Faculty Collaboration Database

Frequency and Duration of Incarceration and Mortality Among US Veterans With and Without HIV. J Acquir Immune Defic Syndr 2020 Jun 01;84(2):220-227

Date

02/13/2020

Pubmed ID

32049771

Pubmed Central ID

PMC7228828

DOI

10.1097/QAI.0000000000002325

Scopus ID

2-s2.0-85084694093 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

BACKGROUND: Exposure to incarceration is associated with increased risk of mortality, and HIV is cited as a leading cause of death. Yet, few studies have examined the association between incarceration and mortality among people with HIV (PWH), specifically whether and how increasing exposure to incarceration increases risk of mortality. We compared mortality by different incarceration exposures and HIV status.

METHODS: We conducted a prospective cohort study of participants in the Veterans Aging Cohort Study from January 2011 to August 2017 (N = 5367). The primary exposure was incarceration by 3 measures: (1) any (ever/never); (2) frequency; and (3) cumulative duration. Stratifying by HIV status and controlling for age, race, and sex, we used Cox Proportional Hazard models to estimate adjusted hazard ratios (AHRs) and 95% confidence intervals (CIs).

RESULTS: Incarceration was associated with increased risk of mortality compared with those never incarcerated for PWH (AHR 1.37; 95% CI: 1.13 to 1.66) and those uninfected (AHR 1.24; 95% CI: 0.99 to 1.54), but the association was only statistically significant among PWH. Increasing frequency of incarceration was associated with higher risk of mortality in both groups: for PWH, AHRs 1.13, 1.45, and 1.64 for 1, 2-5; 6+ times, respectively, for uninfected, AHRs 0.98, 1.35, and 1.70 for 1, 2-5, and 6+ times, respectively.

CONCLUSIONS: PWH were at increased risk of mortality after incarceration, and repeated exposure to incarceration was associated with mortality in both groups in a dose-response fashion. This increased risk of mortality may be mitigated by improving transitional health care, especially HIV care, and reducing incarceration.

Author List

Hawks LC, McGinnis KA, Howell BA, Khan MR, Edelman EJ, Justice AC, Wang EA

Author

Laura C. Hawks MD, MPH Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Female
HIV Infections
HIV-1
Humans
Male
Middle Aged
Prisons
Risk Factors
United States
Veterans