Regional and Temporal Changes in HIV-related Mortality in British Columbia, 1987-2006

Background: HIV-related mortality has been declining in Canada; however, little is known about regional differences in HIV-related mortality. The objective of this study was to characterize regional changes in HIV-related mortality from 1987-2006 in British Columbia (BC). Methods: BC Vital Statistics provided death certificate data for individuals ³18 years who died of an HIV-related cause in BC between 1987 and 2006. Annual mortality rates were calculated for all BC, five regional health authorities, and two areas within Vancouver. Joinpoint regression analyses measured changes in mortality rates. Results: There were 3,899 HIV-related deaths in BC from 1987-2006. Over time, HIV-related mortality rates were highest in the densely populated, southern regions, and lowest in the north. In BC, mortality significantly increased from 1987-1994 (annual percent change [APC] 16.3%). In 1994, the trend changed to a significant decrease in mortality from 1994-1998 (APC -20.0%), followed by a sustained reduction from 1998-2006. Four of the five health authorities showed mortality trends similar to the province; however, the north showed significantly increasing mortality from 1987-2006 (APC 6.7%). In Vancouver, the City Centre showed a mortality pattern similar to the province, but the Downtown Eastside had rising mortality rates until 1997, followed by a modest decline. Conclusion: In most areas of BC, HIV-related mortality declined after the introduction of effective antiretroviral therapy; however, this decline was delayed or absent in some regions. These regional variations may reflect differential access to health care, even in a setting where antiretroviral therapy is provided at no cost to patients. Key words: Mortality; mortality decline; death rate; HIV; Canada; British Columbia