The Impact of Subgroup-Specific Heterogeneities and Dynamic Changes in Mortality Rates on Forecasted Population Size, Deaths and Age Distribution of Persons Receiving Antiretroviral Treatment in the United States: A Computer Simulation Study

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Citation

Kasaie, Parastu; Stewart, Cameron; Humes, Elizabeth; Gerace, Lucas; Hyle, Emily P.; Zalla, Lauren C.; Rebeiro, Peter F.; Silverberg, Michael J.; Rubtsova, Anna A.; & Rich, Ashleigh J., et al. (2023). The Impact of Subgroup-Specific Heterogeneities and Dynamic Changes in Mortality Rates on Forecasted Population Size, Deaths and Age Distribution of Persons Receiving Antiretroviral Treatment in the United States: A Computer Simulation Study. Annals of Epidemiology, 87, 69-78.e32.

Abstract

BACKGROUND: Model-based forecasts of population size, deaths, and age distribution of people with HIV (PWH) are helpful for public health and clinical services planning but are influenced by subgroup-specific heterogeneities and changes in mortality rates.
METHODS: Using an agent-based simulation of PWH in the US, we examined the impact of distinct approaches to parametrizing mortality rates on forecasted epidemiology of PWH on ART. We first estimated mortality rates among 1) all PWH, 2) sex-specific, 3) sex-and-race/ethnicity-specific, and 4) sex-race/ethnicity-and-HIV-acquisition-risk-specific subgroups. We then assessed each scenario by 1) allowing unrestricted reductions in age-specific mortality rates over time, and 2) restricting the mortality rates among PWH to subgroup-specific mortality thresholds from the general population.
RESULTS: Among the eight scenarios examined, those lacking subgroup-specific heterogeneities and those allowing unrestricted reductions in future mortality rates forecasted the lowest number of deaths among all PWH and 9 of the 15 subgroups through 2030. The forecasted overall number and age distribution of people with a history of injection drug use were sensitive to inclusion of subgroup-specific mortality rates.
CONCLUSIONS: Our results underscore the potential risk of underestimating future deaths by models lacking subgroup-specific heterogeneities in mortality rates, and those allowing unrestricted reductions in future mortality rates.

URL

http://dx.doi.org/10.1016/j.annepidem.2023.09.005

Reference Type

Journal Article

Year Published

2023

Journal Title

Annals of Epidemiology

Author(s)

Kasaie, Parastu
Stewart, Cameron
Humes, Elizabeth
Gerace, Lucas
Hyle, Emily P.
Zalla, Lauren C.
Rebeiro, Peter F.
Silverberg, Michael J.
Rubtsova, Anna A.
Rich, Ashleigh J.
Gebo, Kelly A.
Lesko, Catherine R.
Fojo, Anthony T.
Lang, Raynell
Edwards, Jessie K.
Althoff, Keri N.

Article Type

Regular

ORCiD

Edwards, J -0000-0002-1741-335X