A Study On The Distribution Of Suicide Deaths And Related Disease Burden Among HIV-infected People In China

Background:Highly Active Antiretroviral Therapy(HARRT)can inhibit the replication of Human Immunodeficiency Virus(HIV)and promote immune system recovering.Effective antiviral treatment can reduce the mortality rate among people living with HIV(PLHIV).However,HIV infection is still incurable disability caused by infection might cause severe burden of disease.Studies from China and other countries also have founded that PLHIV have mental health problems such as depression and anxiety,and the incidence rate for mental illness is higher than the general people.Therefore,the mental health problems and burden of disease among PLHIV in China need to be explored.Objective:Based on the " HIV/AIDS Comprehensive Response Information Management System" data from 1993 to 2012,we comprehensively described the epidemiological characteristics and mortality rate changes among PLHIV in China.Based on the " HIV/AIDS Comprehensive Response Information Management System"data from 2013 to 2018,we analyze the suicide and mental health among PLHIV to explore the spatial distribution characteristics and influencing factors of suicide among PLHIV.Then,we estimated the expected survival time of infected people and explored the burden of mental illness among PLHIV in China based on the epidemiological survey data.And to estimate the burden of disease due to mental disorders.Methods:1.Based on the "HIV/AIDS Comprehensive Response Information Management System" data,we analyzed the change of mortality by interrupted time series analysis to explore the change of mortality rate among PLHIV before and after the implementation of "Four Free and One Care" policy in China.2.Spatial analysis was conducted to analyze the characteristics of the prevalence of suicide among PLHIV from 2013 to 2018.Multivariate logistic regression model was used to analyze the influencing factors of individual level for suicide among PLHIV.The geographically weighted regression model was used to analyze the social economic factors for suicide among PLHIV.3.According to the distribution characteristics and main influencing factors of suicide,we selected field sites to conduct epidemiological investigation We explored the mental health status,medical costs and ART treatment.Structural equation model was used to explore the relationship between psychological characteristics among PLWH.4.Based on the " HIV/AIDS Comprehensive Response Information Management System" data,we estimated the expected survival time of PLWH and the expected survival time due to suicide in 2004,2012,and 2018.Then we the estimated the mental related burden of disease of PLHIV,and the disability weight was estimated according to the score of psychosocial scales.Results:1.HIV mortality changes:It was indicated that the life span of PLHIV in China has been prolonged after antiviral therapy.In detail,the AIDS-related mortality rate increased from 1993 to 2003.The results of interrupted time series analysis showed that the rate decreased in 2004.After the implementation of the policy(2005-2012),the slope of AIDS-related mortality rate showed a decreasing trend.2.Characteristics of suicide among PLHIV:(1)Distribution:It was suggested that there were differences in the geographical distribution between the prevalence of AIDS and the suicide deaths of PLHIV in China.The top five provinces in terms of suicide mortality were Hubei,Hunan,Anhui,Jiangxi and Henan.Anhui(8.15%),Hubei(7.27%),Hunan(5.28%),Shandong(4.78%)and Jiangsu(4.59%)were the top five provinces in terms of the suicide proportion among total death.The central southern and eastern regions of China were the hot spots of suicide mortality and suicide proportion.Cold spots were mainly distributed in the northeast,northwest and southwest of China.(2)Individual level influencing factors for suicide:Results showed that being single,high school education or above,were risk factors for suicide death(p<0.001).Compared with PLHIV aged 50 and above,aged<30 years(aOR=2.602,95%CI:2.200-3.078),aged between 30 and 40 years(aOR=1.708,95%CI:1.490-1.957),and age between 40 and 50 years(aOR=1.518,95%CI:1.355-1.701)were risk factors for death caused by suicide.And compared with heterosexual sexual transition,homosexual was a risk factor for suicide death in PLHIV(aOR+1.776,95%CI:1.570-2.009).(3)Macro factors:Economic coefficients were negative except for Xinjiang Uygur Autonomous Region and Heilongjiang Province,which indicated that the economic level had a negative correlation with the suicide proportion in the whole country.The distribution of traffic coefficient showed that the traffic coefficient was positive at the provincial level,which was positively correlated with the proportion of suicide deaths.The medical coefficient was negative at the provincial level,and the medical level was negatively correlated with the proportion of suicide deaths,showing a gradually increasing trend from the southwest to the northwest and northeast.3.Mental status among PLWH:Among the respondents,51.76%(500/966)had depressive symptoms,23.08%(223/966)had suicidal ideation in past six months.Field survey results were used as the main basis for estimating disability weight in disease burden.4.Burden of disease due to mental disorders among PLWH(1)The life expectancy prolonged as the antiviral treatment.The results showed that,with the development of antiviral treatment.Based on the number of suicide deaths at each time point,the life expectancy due to suicide was calculated.Comparing the difference,the life loss due to suicide was the highest in 2012.(2)YLLs and YLDs were used to analyze the disease burden of HIV infected persons.Field survey results were used as the main basis for estimating disability weight in disease burden.In 2018,182 newly reported PLHIV died by suicide,resulting in a total of 2275.98 person-years of YLLs and 27563.53 person-years of YLDs.YLDs was the highest in 25-34(6012.3 person years)years old group,and increased compared with 15-24 years old group,and then decreased with age.YLLs caused by suicide were higher in the 25?34(470.83 person years)years-old and the 45?54(677.84 person years)years-old,and the 15?24(211.22 person years)years old accounted for the highest proportion of total YLLs(5.46%).Conclusion:1.Based on the national case report data,this study found that the mortality decreased among PLHIV.2.The regional distribution of suicide deaths among PLHIV in China was inconsistent with the regional distribution of HIV epidemic situation.And suicide presented spatial clustering,which provided the basis for the development of regional intervention policies for PLHIV in China.The suicide among PLHIV reported in China were affected by both individual and macro factors,which provided objective evidence for the exploration of suicide among HIV infected persons.3.C ombined with the multi-center epidemiological field investigation,the burden of disease was estimated for the first time based on PLHIV.We estimated the life expectancy,and the burden of psychosocial diseases which provided localized data for the study of the burden of disease on mental health in China,which showed a total of 2275.98 person-years of YLLs and 27563.53 person-years of YLDs.It provided a scientific basis for the possible benefits of mental health intervention based on antiviral therapy for HIV infected patients in the future.