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
02/13/2020Pubmed ID
32049771Pubmed Central ID
PMC7228828DOI
10.1097/QAI.0000000000002325Scopus ID
2-s2.0-85084694093 (requires institutional sign-in at Scopus site) 5 CitationsAbstract
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 EAAuthor
Laura C. Hawks MD, MPH Assistant Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
FemaleHIV Infections
HIV-1
Humans
Male
Middle Aged
Prisons
Risk Factors
United States
Veterans