translation agency

Near complete reporting of HIV/AIDS deaths in a province wide treatment program.
Le T; Uh SH; Hogg RS; Heath KV; Montaner JS; O'Shaughnessy MV; Schechter
January 30, 1997
Int Conf AIDS. 1996 Jul 7-12;11(1):149 (abstract no. Mo.C.1545). Unique

Objective: To assess underreporting of HIV/AIDS on death certificates in British Columbia (BC). Methods: Antiretroviral and selected anti-opportunistic drugs are offered free of charge and province wide to eligible HIV-infected individuals through the provincial Drug Treatment Program. Study subjects were individuals who had ever enrolled in the treatment program and had died during the period Jan. 1, 1993 to Dec. 31, 1994. Vital status at Dec. 31, 1994 was determined through a record linkage performed with the death registry of the Division of Vital Statistics of the Ministry of Health. Vital status information was augmented with epidemiological and clinical data from the treatment program. Statistical analyses were carried out using both parametric and distribution-free methods. All reported p-values are two-sided. Results: A total of 403 deaths were identified and linked non-nominally, of which 373 (92.6%) mentioned and 30 (7.4%) did not mention HIV/AIDS (ICD-9 042-044) on the death certificate. Of the 373 deaths which mentioned HIV/AIDS, this cause was recorded as the underlying cause of death in 360 (96.5%) deaths and the antecedent cause in 13 3.5%). The 30 deaths not attributed to HIV/AIDS were due to other infectious or parasitic agents (n=5), cancers (n=3), metabolic and immunity disorders (n=2), circulatory and digestive systems diseases (n=3), unknown conditions (n=4), motor vehicle accidents (n=1), accidental medication overdose (n=5), or suicide n=7). In comparison to deaths attributed to HIV/AIDS, deaths attributed to other causes were significantly more likely to occur in individuals who had a higher median CD4 cell count within 6 months before death (130 versus 20 cells; p = 0.001) or an autopsy (70.0% versus 4.8%; p less than 0.001). No statistical difference was found between the two groups with respect to gender, age, location of death, residence, marital status, year of death, or length of time from the last CD4 count to death. Conclusions: Our results indicate that HIV/AIDS was not reported on the death certificate for only 7.4% of all deaths recorded in the treatment program. Although the true level of underreporting in BC cannot be accurately estimated from this study, it appeares that most deaths of HIV-positive persons receiving antiretroviral therapy in BC are being attributed to HIV/AIDS in the provincial death registry.

*Acquired Immunodeficiency Syndrome/MORTALITY *HIV Infections/MORTALITY