Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Michael A. Cork; Nathaniel J. Henry; Stefanie Watson; Andrew J. Croneberger; Mathew Baumann; Ian D. Letourneau; Mingyou Yang; Audrey L. Serfes; Jaffar Abbas; Nooshin Abbasi; Hedayat Abbastabar; Lucas G. Abreu; Eman Abu-Gharbieh; Basavaprabhu Achappa; Maryam Adabi; Tadele G. Adal; Adeyinka E. Adegbosin; Victor Adekanmbi; Olatunji O. Adetokunboh; Marcela Agudelo-Botero; Bright O. Ahinkorah; Keivan Ahmadi; Muktar B. Ahmed; Robert K. Alhassan; Vahid Alipour; Amir Almasi-Hashiani; Nelson Alvis-Guzman; Robert Ancuceanu; Tudorel Andrei; Davood Anvari; Muhammad Aqeel; Jalal Arabloo; Olatunde Aremu; Malke Asaad; Desta D. Atnafu; Alok Atreya; Beatriz Paulina Ayala Quintanilla; Samad Azari; Darshan B. B; Atif A. Baig; Maciej Banach; Simachew A. Bante; Miguel A. Barboza; Sanjay Basu; Neeraj Bedi; Diana F.Bejarano Ramirez; Isabela M. Bensenor; Fenta Hun Y. Beyene; Yihienew M. Bezabih; Paul H. Lee

doi:10.1186/s12916-020-01876-4

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Michael A. Cork
, Nathaniel J. Henry
, Stefanie Watson
, Andrew J. Croneberger
, Mathew Baumann
, Ian D. Letourneau
, Mingyou Yang
, Audrey L. Serfes
, Jaffar Abbas
, Nooshin Abbasi
, Hedayat Abbastabar
, Lucas G. Abreu
, Eman Abu-Gharbieh
, Basavaprabhu Achappa
, Maryam Adabi
, Tadele G. Adal
, Adeyinka E. Adegbosin
, Victor Adekanmbi
, Olatunji O. Adetokunboh
, Marcela Agudelo-Botero

Bright O. Ahinkorah, Keivan Ahmadi, Muktar B. Ahmed, Robert K. Alhassan, Vahid Alipour, Amir Almasi-Hashiani, Nelson Alvis-Guzman, Robert Ancuceanu, Tudorel Andrei, Davood Anvari, Muhammad Aqeel, Jalal Arabloo, Olatunde Aremu, Malke Asaad, Desta D. Atnafu, Alok Atreya, Beatriz Paulina Ayala Quintanilla, Samad Azari, Darshan B. B, Atif A. Baig, Maciej Banach, Simachew A. Bante, Miguel A. Barboza, Sanjay Basu, Neeraj Bedi, Diana F.Bejarano Ramirez, Isabela M. Bensenor, Fenta Hun Y. Beyene, Yihienew M. Bezabih, Paul H. Lee

University of Washington
University of Oxford
Antai College of Economics and Management
McGill University
Tehran University of Medical Sciences
Universidade Federal de Minas Gerais
University of Sharjah
Manipal Academy of Higher Education
Hamedan University of Medical Sciences and Health Services
Wolkite University
Griffith University Queensland
Kings College London
Stellenbosch University
Universidad Nacional Autónoma de México
University of Technology Sydney
Lincoln Medical School
Jimma University Ethiopia
University of South Australia
University of Health and Allied Sciences
Iran University of Medical Sciences
Arak University of Medical Sciences
Universidad de Cartagena
ALZAK Foundation
Carol Davila University of Medicine and Pharmacy
Bucharest University of Economic Studies
Mazandaran University of Medical Sciences
Iranshahr University of Medical Sciences
Foundation University Islamabad
Birmingham City University
University of Texas Health Science Center at Houston
Bahar Dar University
Lumbini Medical College
La Trobe University
Universiti Sultan Zainal Abidin
Medical University of Łódź
Institute of Polish Mother's Health Center
Costa Rican Department of Social Security
University of Costa Rica
Harvard University
Imperial College London
Gandhi Medical College
Jazan University
Universidad El Bosque
University Hospital Foundation Santa Fe de Bogotá
Universidade de São Paulo
Nantes Université
Hong Kong Polytechnic University

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.

Original language	English
Article number	4
Journal	BMC Medicine
Volume	19
Issue number	1
DOIs	https://doi.org/10.1186/s12916-020-01876-4
Publication status	Published - Dec 2021
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

ASJC Scopus subject areas

General Medicine

Keywords

HIV mortality
HIV/AIDS
Latin America
Mapping
Small area estimation
Spatial statistics
Vital registration

Access to Document

10.1186/s12916-020-01876-4

Cite this

Cork, M. A., Henry, N. J., Watson, S., Croneberger, A. J., Baumann, M., Letourneau, I. D., Yang, M., Serfes, A. L., Abbas, J., Abbasi, N., Abbastabar, H., Abreu, L. G., Abu-Gharbieh, E., Achappa, B., Adabi, M., Adal, T. G., Adegbosin, A. E., Adekanmbi, V., Adetokunboh, O. O., ... Lee, P. H. (2021). Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems. BMC Medicine, 19(1), Article 4. https://doi.org/10.1186/s12916-020-01876-4

@article{8004eb397221489a9242aee674d2830e,

title = "Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems",

abstract = "Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries{\textemdash}apart from Ecuador{\textemdash}across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50\% or more HIV deaths were concentrated in fewer than 10\% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups{\textemdash}the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.",

keywords = "HIV mortality, HIV/AIDS, Latin America, Mapping, Small area estimation, Spatial statistics, Vital registration",

author = "Cork, \{Michael A.\} and Henry, \{Nathaniel J.\} and Stefanie Watson and Croneberger, \{Andrew J.\} and Mathew Baumann and Letourneau, \{Ian D.\} and Mingyou Yang and Serfes, \{Audrey L.\} and Jaffar Abbas and Nooshin Abbasi and Hedayat Abbastabar and Abreu, \{Lucas G.\} and Eman Abu-Gharbieh and Basavaprabhu Achappa and Maryam Adabi and Adal, \{Tadele G.\} and Adegbosin, \{Adeyinka E.\} and Victor Adekanmbi and Adetokunboh, \{Olatunji O.\} and Marcela Agudelo-Botero and Ahinkorah, \{Bright O.\} and Keivan Ahmadi and Ahmed, \{Muktar B.\} and Alhassan, \{Robert K.\} and Vahid Alipour and Amir Almasi-Hashiani and Nelson Alvis-Guzman and Robert Ancuceanu and Tudorel Andrei and Davood Anvari and Muhammad Aqeel and Jalal Arabloo and Olatunde Aremu and Malke Asaad and Atnafu, \{Desta D.\} and Alok Atreya and Quintanilla, \{Beatriz Paulina Ayala\} and Samad Azari and B, \{Darshan B.\} and Baig, \{Atif A.\} and Maciej Banach and Bante, \{Simachew A.\} and Barboza, \{Miguel A.\} and Sanjay Basu and Neeraj Bedi and Ramirez, \{Diana F.Bejarano\} and Bensenor, \{Isabela M.\} and Beyene, \{Fenta Hun Y.\} and Bezabih, \{Yihienew M.\} and Lee, \{Paul H.\}",

note = "Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2021",

month = dec,

doi = "10.1186/s12916-020-01876-4",

language = "English",

volume = "19",

journal = "BMC Medicine",

issn = "1741-7015",

publisher = "BioMed Central Ltd.",

number = "1",

}

Cork, MA, Henry, NJ, Watson, S, Croneberger, AJ, Baumann, M, Letourneau, ID, Yang, M, Serfes, AL, Abbas, J, Abbasi, N, Abbastabar, H, Abreu, LG, Abu-Gharbieh, E, Achappa, B, Adabi, M, Adal, TG, Adegbosin, AE, Adekanmbi, V, Adetokunboh, OO, Agudelo-Botero, M, Ahinkorah, BO, Ahmadi, K, Ahmed, MB, Alhassan, RK, Alipour, V, Almasi-Hashiani, A, Alvis-Guzman, N, Ancuceanu, R, Andrei, T, Anvari, D, Aqeel, M, Arabloo, J, Aremu, O, Asaad, M, Atnafu, DD, Atreya, A, Quintanilla, BPA, Azari, S, B, DB, Baig, AA, Banach, M, Bante, SA, Barboza, MA, Basu, S, Bedi, N, Ramirez, DFB, Bensenor, IM, Beyene, FHY, Bezabih, YM & Lee, PH 2021, 'Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems', BMC Medicine, vol. 19, no. 1, 4. https://doi.org/10.1186/s12916-020-01876-4

TY - JOUR

T1 - Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

AU - Cork, Michael A.

AU - Henry, Nathaniel J.

AU - Watson, Stefanie

AU - Croneberger, Andrew J.

AU - Baumann, Mathew

AU - Letourneau, Ian D.

AU - Yang, Mingyou

AU - Serfes, Audrey L.

AU - Abbas, Jaffar

AU - Abbasi, Nooshin

AU - Abbastabar, Hedayat

AU - Abreu, Lucas G.

AU - Abu-Gharbieh, Eman

AU - Achappa, Basavaprabhu

AU - Adabi, Maryam

AU - Adal, Tadele G.

AU - Adegbosin, Adeyinka E.

AU - Adekanmbi, Victor

AU - Adetokunboh, Olatunji O.

AU - Agudelo-Botero, Marcela

AU - Ahinkorah, Bright O.

AU - Ahmadi, Keivan

AU - Ahmed, Muktar B.

AU - Alhassan, Robert K.

AU - Alipour, Vahid

AU - Almasi-Hashiani, Amir

AU - Alvis-Guzman, Nelson

AU - Ancuceanu, Robert

AU - Andrei, Tudorel

AU - Anvari, Davood

AU - Aqeel, Muhammad

AU - Arabloo, Jalal

AU - Aremu, Olatunde

AU - Asaad, Malke

AU - Atnafu, Desta D.

AU - Atreya, Alok

AU - Quintanilla, Beatriz Paulina Ayala

AU - Azari, Samad

AU - B, Darshan B.

AU - Baig, Atif A.

AU - Banach, Maciej

AU - Bante, Simachew A.

AU - Barboza, Miguel A.

AU - Basu, Sanjay

AU - Bedi, Neeraj

AU - Ramirez, Diana F.Bejarano

AU - Bensenor, Isabela M.

AU - Beyene, Fenta Hun Y.

AU - Bezabih, Yihienew M.

AU - Lee, Paul H.

PY - 2021/12

Y1 - 2021/12

N2 - Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.

AB - Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.

KW - HIV mortality

KW - HIV/AIDS

KW - Latin America

KW - Mapping

KW - Small area estimation

KW - Spatial statistics

KW - Vital registration

UR - https://www.scopus.com/pages/publications/85102170519

U2 - 10.1186/s12916-020-01876-4

DO - 10.1186/s12916-020-01876-4

M3 - Article

C2 - 33413343

AN - SCOPUS:85102170519

SN - 1741-7015

VL - 19

JO - BMC Medicine

JF - BMC Medicine

IS - 1

M1 - 4

ER -

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Abstract

UN SDGs

ASJC Scopus subject areas

Keywords

Access to Document

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