Demographical and Regional Trends of HIV-Related Mortality Among Young Adults in the United States From 1999 to 2020

Background: HIV remains a leading cause of death in the U.S. Previous research has examined mortality patterns among older adults with HIV, revealing regional and demographic disparities. This study aims to assess demographic and regional trends in HIV-related mortality among young adults from 1999 to 2020.

Methods: Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was used to identify young adults aged 15-44 where HIV was mentioned as either underlying or contributory cause of mortality between 1999 and 2020, using the B20-B24 codes from the International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10). Age-adjusted mortality rates (AAMRs) per 100,000 population and annual percentage change (APC) were determined.

Results: The AAMRs for HIV in young adults consistently declined from 1999 to 2018, followed by a period of stability from 2018 to 2020 (annual percentage change: 0.5%; 95% confidence interval [95% CI], -7.4 to 9.0), with 64% deaths occurred in medical facilities. Overall, males had a twice AAMR than females (female: 2.22, 95% CI 2.19-2.24; male: 5.19, 95% CI 5.15-5.23). Non-Hispanic (NH) Blacks had sevenfold higher mortality rates than Whites (AAMR 14.88 vs. 2.036). The Southern region experienced threefold higher mortality compared to the Midwest. Metropolitan adults had a twofold higher AAMR than nonmetropolitan adults. States in the top 90th percentile for HIV-related mortality, including Mississippi, Maryland, Florida, Louisiana, and the District of Columbia, exhibited six times higher mortality compared to states in the bottom 10th percentile, such as North Dakota, Idaho, Wyoming, Montana, and Utah.

Conclusions: To address these disparities and ensure continued progress, urgent measures are required.