Impacts of overdose and socio-structural factors on recent mortality among people living with HIV in British Columbia, Canada.

The study aimed to identify sociodemographic and behavioral factors associated with mortality among people living with HIV (PLWH) in British Columbia, Canada. The research team recruited a representative cohort of 644 PLWH aged 19 years and above between January 2016 and September 2018. Participants completed a survey and consented to link their data with the BC Vital Statistics Agency, which recorded deaths. The results showed that as of September 2021, 71 (11.0%) of the participants had died. The most common cause of death was overdose, accounting for 19.7% of the deaths. The study found significant differences in characteristics between participants who died and those who were alive at the end of the follow-up period. For instance, a higher proportion of individuals who died had a history of incarceration, recent homelessness, and recent injection drug use compared to those who were alive. The study used multivariable Cox proportional hazards models to examine the factors associated with mortality. The results showed that age 60 and above, and experiencing homelessness in the last 12 months prior to enrollment were associated with an increased risk of death. In contrast, identifying as gay or lesbian and having greater social support were found to be protective factors. Specifically, the adjusted hazard ratio (aHR) for age 60 and above was 3.80, indicating a nearly four-fold increased risk of death. The aHR for experiencing homelessness was 2.01, indicating a two-fold increased risk of death. On the other hand, the aHR for identifying as gay or lesbian was 0.42, indicating a reduced risk of death. The study also found that for every 10-unit increase in social support score, the risk of death decreased by 12%. The findings suggest that PLWH with higher social support have a lower risk of death, highlighting the importance of social support in reducing mortality among this population. Overall, the study's results emphasize the need to address the social determinants of health, such as homelessness and social isolation, to improve the health outcomes of PLWH in British Columbia.