Life Expectancy Among People With HIV in New York City, 2009-2018.

OBJECTIVE: To conduct a population-based analysis and compare life expectancy between people with HIV and the general population in New York City (NYC). METHODS: We obtained the annual total number and age, sex, and race/ethnicity distributions of people with HIV from the NYC HIV registry and generated comparable numbers for the NYC general population from the Census 2000 and 2010 data using linear interpolation. RESULTS: Life expectancy at age 20 among people with HIV increased from 38.5 years [95% confidence interval (CI): 37.4 to 39.5] in 2009 to 50.6 (95% CI: 48.5 to 52.7) in 2018, whereas it increased from 62.0 years (95% CI: 61.8 to 62.1) to 63.6 (95% CI: 63.5 to 63.7) among the NYC general population. The gap between the 2 populations narrowed from 23.5 years (95% CI: 22.4 to 24.6) in 2009 to 13.0 (95% CI: 10.9 to 15.1) in 2018. By sex and race/ethnicity, life expectancy at age 20 among people with HIV increased from 36.7 years in 2009 to 47.9 in 2018 among Black men; 37.5 to 50.5 years among Black women; 38.6 to 48.9 years among Hispanic men; 46.0 to 51.0 years among Hispanic women; 44.7 to 59.7 years among White men; and 38.0 years in 2009-2013 to 50.4 years in 2014-2018 among White women. CONCLUSIONS: Life expectancy among people with HIV improved greatly in NYC in 2009-2018, but the improvement was not equal across sex and racial/ethnic groups. The gap in life expectancy between people with HIV and the general population narrowed but remained.

Adverse Trends in Ischemic Heart Disease Mortality among Young New Yorkers, Particularly Young Black Women.

BACKGROUND: Ischemic heart disease (IHD) mortality has been on the decline in the United States for decades. However, declines in IHD mortality have been slower in certain groups, including young women and black individuals. HYPOTHESIS: Trends in IHD vary by age, sex, and race in New York City (NYC). Young female minorities are a vulnerable group that may warrant renewed efforts to reduce IHD. METHODS: IHD mortality trends were assessed in NYC 1980-2008. NYC Vital Statistics data were obtained for analysis. Age-specific IHD mortality rates and confidence bounds were estimated. Trends in IHD mortality were compared by age and race/ethnicity using linear regression of log-transformed mortality rates. Rates and trends in IHD mortality rates were compared between subgroups defined by age, sex and race/ethnicity. RESULTS: The decline in IHD mortality rates slowed in 1999 among individuals aged 35-54 years but not ≥55. IHD mortality rates were higher among young men than women age 35-54, but annual declines in IHD mortality were slower for women. Black women age 35-54 had higher IHD mortality rates and slower declines in IHD mortality than women of other race/ethnicity groups. IHD mortality trends were similar in black and white men age 35-54. CONCLUSIONS: The decline in IHD mortality rates has slowed in recent years among younger, but not older, individuals in NYC. There was an association between sex and race/ethnicity on IHD mortality rates and trends. Young black women may benefit from targeted medical and public health interventions to reduce IHD mortality.

Increased Life Expectancy in New York City, 2001-2010: An Exploration by Cause of Death and Demographic Characteristics.

OBJECTIVE: New York City's (NYC's) life expectancy gains have been greater than those seen nationally. We examined life-expectancy changes over the past decade in selected NYC subpopulations and explored which age groups and causes of death contributed most to the increases. METHODS: We calculated life expectancy with 95% confidence intervals (CIs) for 2001-2010 by sex and race/ethnicity. Life expectancy was decomposed by age group and cause of death. Logistic regressions were conducted to reinforce the results from decomposition by controlling confounders. RESULTS: Overall, NYC residents' life expectancy at birth increased from 77.9 years (95% CI, 77.8-78.0) in 2001 to 80.9 years (95% CI, 80.8-81.0) in 2010. Decreases in deaths from heart disease, cancer, and HIV disease accounted for 50%, 16%, and 11%, respectively, of the gains. Decreased mortality in older age groups (≥65 years) accounted for 45.6% of the overall change. CONCLUSIONS: Life expectancy increased for both sexes, across all racial/ethnic groups, and for both the US-born and the foreign-born. Disparities in life expectancy decreased as overall life expectancy increased. Decreased mortality among older adults and from heart disease, cancer, and HIV infection accounted for most of the increases.

Diabetes and ischemic heart disease death in people age 25-54: a multiple-cause-of-death analysis based on over 400 000 deaths from 1990 to 2008 in New York City.

BACKGROUND: Over the past decade, ischemic heart disease (IHD) mortality trends have been less favorable among adults age 25-54 than age ≥55 years. HYPOTHESIS: Disorders associated with IHD such as diabetes, chronic inflammatory and infectious diseases, and cocaine use are important contributors to premature IHD mortality. METHODS: Multiple-cause-of-death analysis was performed using the New York City (NYC) Vital Statistics database. Frequencies of selected contributing causes on death records with IHD as the underlying cause for decedents age ≥25 were assessed (n = 418,151; 1990-2008). Concurrent Telephone risk-factor surveys (NYC Community Health Survey, Centers for Disease Control Behavioral Risk Factor Survey in New York State) were analyzed. RESULTS: In sum, a prespecified contributing cause was identified on 13.6% of death certificates for IHD decedents age 25-54. Diabetes was reported more frequently for younger IHD decedents (15% of females and 10% of males age 25-54 vs 6% of both sexes age ≥ 55). In contrast, concurrent diabetes prevalence in New York State was 3.4% for those age 25-54 and 13.6% for those age >55 (P < 0.0001). Systemic lupus erythematosus, human immunodeficiency virus, and cocaine were also more likely to contribute to IHD death among younger than older people. CONCLUSIONS: Diabetes may be a potent risk factor for IHD death in young people, particularly young women, in whom it was reported on IHD death records at a rate 5× higher than local prevalence. The high frequency of reporting of studied contributing causes in younger IHD decedents may provide a focus for further IHD mortality-reduction efforts in younger adults.

Improving functional outcomes in home care patients: impact and challenges of disseminating a quality improvement initiative.

Most older adults are admitted to home health care with some functional impairment related to chronic illness and/or hospitalization. This article describes: (1) the impact of a quality improvement initiative (QI) on functional outcomes of older, chronically ill patients served by a large homecare organization; and (2) key implementation challenges affecting intervention outcomes. Over 6,000 patients were included in two dissemination phases. Phase 1 randomly assigned service delivery teams to intervention (QI) or usual care (UC). Phase 2 spread the intervention to UC teams. Phase 1 yielded statistically significant, albeit modest, functional improvements among intervention team patients relative to UC. Phase 2 improvements in the original intervention group were smaller, suggesting some regression to the mean. UC teams did not "catch up" when exposed to the intervention in Phase 2. Analysis of the implementation process suggested that modification of improvement strategies and "dilution" of peer-to-peer communication hindered additional Phase 2 improvements. The findings highlight the challenges of relying on peer-to-peer spread, and of distinguishing the core elements of an effective improvement strategy that must be spread consistently from those that can be adapted to variations within and across organizations.