Syndemic trajectories of heavy drinking, smoking, and depressive symptoms are associated with mortality in women living with HIV in the United States from 1994 to 2017.

BACKGROUND: Heavy drinking, smoking, and depression are common among people with HIV. Little is known about the co-occurring, synergistic effect of having two or more of these conditions long-term -a sustained syndemic - on mortality among women with HIV (WWH). METHODS: Data from 3282 WWH of the Women's Interagency HIV Study from 1994 to 2017 were utilized. National Death Index review identified cause of death (n=616). Sustained syndemic phenotypes were based on membership in high-risk groups defined by group-based trajectory models of repeated self-reported alcohol use, smoking, and depressive symptoms and their co-occurrence. Cox proportional hazard models estimated associations of sustained syndemic phenotypes with all-cause, non-AIDS, and non-overdose mortality, adjusting for age, race/ethnicity, education, enrollment wave, illicit drug use, and time-varying HIV viral load and CD4+ T-cell count. RESULTS: WWH were 58% Black and 26% Hispanic, with a mean baseline age of 36.7 years. Syndemic phenotypes included zero (45%, n=1463), heavy drinking only (1%, n=35), smoking only (28%, n=928), depressive symptoms only (9%, n=282), and 2+ trajectories (17%, n=574). Compared to zero trajectories, having 2+ trajectories was associated with 3.93 times greater all-cause mortality risk (95% CI 3.07, 5.04) after controlling for confounders and each high-risk trajectory alone. These findings persisted in sensitivity analyses, removing AIDS- and overdose-related mortalities. CONCLUSIONS: Clustering of 2+ conditions of heavy drinking, smoking, and depression affected nearly one in five WWH and was associated with higher mortality than zero or one condition. Our findings underscore the need for coordinated screening and parsimonious treatment strategies for these co-occurring conditions.

Perfil da Mortalidade por Depressão em Idosos no Estado da Bahia / Profile of Mortality from Depression in Elderly in the State of Bahia / Perfil de la Mortalidad por Depresión en personas mayores en el Estado de Bahía

O objetivo do estudo é descrever o perfil da mortalidade por depressão em idosos no estado da Bahia, no período de 2002 a 2012. Trata-se de um estudo descritivo, transversal, que utilizou dados secundários do Sistema de Informação sobre Mortalidade e do Instituto Brasileiro de Geografia e Estatísticas. A taxa de mortalidade específica por depressão aumentou no período e a maioria dos óbitos ocorreu nos idosos do sexo feminino, com idade ≥80 anos, não brancos, com <4 anos de estudo e solteiros.

The objective of the study is to describe the profile of mortality from depression in the elderly in the state of Bahia from 2002 to 2012. This is a descriptive transversal study that used secondary data from the Mortality Information System and the Brazilian Institute of geography and Statistics. The specific mortality rate for depression increased in the period and most of the deaths occurred in elderly female, aged ≥80 years, not white, <4 years of study and singles.

El objetivo del estudio es describir el perfil de la mortalidad por depresión en mayores en el estado de Bahía de 2002 a 2012. Se trata de un estudio transversal descriptivo que utilizó datos secundarios del Sistema de Información de Mortalidad y del Instituto Brasileño de Geografía Y Estadísticas. La tasa de mortalidad específica por depresión aumentó en el período y la mayoría de las muertes ocurrieron en mujeres mayores, mayores de 80 años, no blancas, <4 años de estudio y solteros.