Background:  Mortality rates among HIV-infected persons have fallen dramatically and remain low in the HAART era. Identifying differences in risk for death based upon sociodemographic factors can enhance public health efforts to further improve survival.

Methods:  We analyzed risks associated with mortality among HIV Outpatient Study (HOPS) patients using multivariable Poisson models that evaluated the following:  sociodemographic factors (age, sex, race, insurance type), HIV clinical status (CD4 cell count/cm³ at HAART initiation [CD4], prior AIDS-defining illness), and co-morbidities (chronic infection with viral hepatitis B or C, illicit drug use, smoking).

Results:  We included data from 2383 persons seen from January 1, 1999 to December 31, 2005 who were followed at least 6 months and had known dates of HAART initiation. Mean duration of follow-up was 5.9 years. The number of deaths observed was 178. We noted discordances in death rates/100 person-years among persons with public vs non-public insurance (4.0 vs 1.3) and among non-Hispanic blacks vs non-blacks or Hispanics (non-blacks) (3.3 vs 1.9), prompting further evaluation in multivariable analyses. In adjusted models, persons with public insurance (Medicare, Medicaid, n = 872) had higher death rates than persons with other types of insurance (n = 1511, adjusted rate ratio [aRR] 1.77, p <0.001). Other factors independently associated with greater mortality risk were non-Hispanic blacks race (aRR 1.52, p = 0.009), advancing age (aRR 1.31 per 10-year increase, p <0.001), and lower CD4 at HAART initiation (aRR 0.900 per 50-cell increase, p <0.001). CD4 at HAART initiation was lower for publicly insured versus non-publicly insured patients (257 vs 311, p <0.001); and for non-Hispanic blacks versus non-blacks (261 vs 301, p <0.001). Cause of death data were available for 77% of persons with either public or non-public insurance, 66% for non-Hispanic blacks, and 83% for non-blacks. Among persons for whom cause of death data were available, non-AIDS-associated deaths predominated for both publicly and non-publicly insured (63% and 56%) and for both non-Hispanic blacks and non-blacks (66% and 56%) and included cardiac, renal, diabetes, and non-AIDS cancer diagnoses.

Conclusions:  Public insurance and non-Hispanic black race were independently associated with increased risk of death after adjusting for other known HIV-related mortality risks. Non-AIDS causes of death that included preventable co-morbid illnesses predominated, suggesting that modifiable health risks may contribute to these disparities.