Twin epidemics: the effects of HIV and systolic blood pressure on mortality risk in rural South Africa, 2010-2019
| dc.contributor.author | Brian Houle | |
| dc.contributor.author | Chodziwadziwa W Kabudula | |
| dc.contributor.author | Andrea M Tilstra | |
| dc.contributor.author | Sanyu A Mojola | |
| dc.contributor.author | Enid Schatz | |
| dc.contributor.author | Samuel J Clark | |
| dc.contributor.author | Nicole Angotti | |
| dc.contributor.author | F Xavier Gómez-Olivé | |
| dc.contributor.author | Jane Menken | |
| dc.date.accessioned | 2024-04-01T18:47:06Z | |
| dc.date.available | 2024-04-01T18:47:06Z | |
| dc.date.issued | 2022-02-22 | |
| dc.description.abstract | Background: Sub-Saharan African settings are experiencing dual epidemics of HIV and hypertension. We investigate effects of each condition on mortality and examine whether HIV and hypertension interact in determining mortality. Methods: Data come from the 2010 Ha Nakekela population-based survey of individuals ages 40 and older (1,802 women; 1,107 men) nested in the Agincourt Health and socio-Demographic Surveillance System in rural South Africa, which provides mortality follow-up from population surveillance until mid-2019. Using discrete-time event history models stratified by sex, we assessed differential mortality risks according to baseline measures of HIV infection, HIV-1 RNA viral load, and systolic blood pressure. Results: During the 8-year follow-up period, mortality was high (477 deaths). Survey weighted estimates are that 37% of men (mortality rate 987.53/100,000, 95% CI: 986.26 to 988.79) and 25% of women (mortality rate 937.28/100,000, 95% CI: 899.7 to 974.88) died. Over a quarter of participants were living with HIV (PLWH) at baseline, over 50% of whom had unsuppressed viral loads. The share of the population with a systolic blood pressure of 140mm Hg or higher increased from 24% at ages 40-59 to 50% at ages 75-plus and was generally higher for those not living with HIV compared to PLWH. Men and women with unsuppressed viral load had elevated mortality risks (men: adjusted odds ratio (aOR) 3.23, 95% CI: 2.21 to 4.71, women: aOR 2.05, 95% CI: 1.27 to 3.30). There was a weak, non-linear relationship between systolic blood pressure and higher mortality risk. We found no significant interaction between systolic blood pressure and HIV status for either men or women (p>0.05). Conclusions: Our results indicate that HIV and elevated blood pressure are acting as separate, non-interacting epidemics affecting high proportions of the older adult population. PLWH with unsuppressed viral load were at higher mortality risk compared to those uninfected. Systolic blood pressure was a mortality risk factor independent of HIV status. As antiretroviral therapy becomes more widespread, further longitudinal follow-up is needed to understand how the dynamics of increased longevity and multimorbidity among people living with both HIV and high blood pressure, as well as the emergence of COVID-19, may alter these patterns. | |
| dc.description.librarian | PM2023 | |
| dc.faculty | Faculty of Health Sciences | |
| dc.identifier.uri | https://hdl.handle.net/10539/38263 | |
| dc.language.iso | en | |
| dc.school | Public Health | |
| dc.subject | Blood pressure; HIV; Hypertension; Mortality; Rural; South Africa. | |
| dc.title | Twin epidemics: the effects of HIV and systolic blood pressure on mortality risk in rural South Africa, 2010-2019 | |
| dc.type | Article |