Influence of geographical origin and ethnicity on mortality in patients on antiretroviral therapy in Canada, Europe, and the United States

Julia Del Amo, Inma Jarrin, Margaret May, Francois Dabis, Heidi Crane, Daniel Podzamczer, Timothy R. Sterling, Sophie Abgrall, Fiona Lampe, Amy Justice, Antonella Castagna, Christoph Boesecke, Cornelia Staehelin, Frank De Wolf, Jodie Guest, Michael J. Mugavero, Pavel Khaykin, Hasina Samji, Suzanne Ingle, Jonathan A C SterneM. John Gill

Research output: Contribution to journalArticlepeer-review


Background. Our objective was to assess differences in all-cause mortality, as well as AIDS and non-AIDS death rates, among patients started on antiretroviral therapy (ART) according to their geographical origin and ethnicity/race in Europe, Canada, and the United States.Methods. This was a collaboration of 19 cohort studies of human immunodeficiency virus-positive subjects who have initiated ART (ART Cohort Collaboration) between 1998 and 2009. Adjusted mortality hazard ratios (AHRs) were estimated using Cox regression. A competing risk framework was used to estimate adjusted subdistribution hazard ratios for AIDS and non-AIDS mortality.Results. Of 46 648 European patients, 16.3% were from sub-Saharan Africa (SSA), 5.1% Caribbean and Latin America, 1.6% North Africa and Middle East, and 1.7% Asia/West; of 1371 patients from Canada, 14.9% were First Nations and 22.4% migrants, and of 7742 patients from North America, 55.5% were African American and 6.6% Hispanic. Migrants from SSA (AHR, 0.79; 95% confidence interval [CI],. 68-.92) and Asia/West (AHR, 0.62; 95% CI,. 41-.92) had lower mortality than Europeans; these differences appeared mainly attributable to lower non-AIDS mortality. Compared with white Canadians, mortality in Canadian First Nations people (AHR, 1.48; 95% CI,. 96-2.29) was higher, both for AIDS and non-AIDS mortality rates. Among US patients, when compared with whites, African Americans had higher AIDS and non-AIDS mortality, and hazard ratios for all-cause mortality increased with time on ART.Conclusions. The lower mortality observed in migrants suggests "healthy migrant" effects, whereas the higher mortality in First Nations people and African Americans in North America suggests social inequality gaps.

Original languageEnglish
Pages (from-to)1800-1809
Number of pages10
JournalClinical Infectious Diseases
Issue number12
Publication statusPublished - Jun 15 2013


  • antiretroviral therapy
  • ethnic minorities
  • HIV infection
  • migrants

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)


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