HIV/AIDS mortality attributable to alcohol use in South Africa: a comparative risk assessment by socioeconomic status
Date
2018-02
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Publishing Group
Abstract
Objectives To quantify HIV/AIDS mortality attributable to
alcohol use in the adult general population of South Africa
in 2012 by socioeconomic status (SES).
Design Comparative risk assessment based on secondary
individual data, aggregate data and risk relations reported
in the literature.
Setting South African adult general population.
Participants For metrics of alcohol use by SES, sex
and age: 27 070 adults that participated in a nationally
representative survey in 2012. For HRs of dying from
HIV/AIDS by SES: 87 029 adults that participated in a
cohort study (years 2000 to 2014) based out of the
Umkhanyakude district, KwaZulu-Natal.
Main outcome measures Alcohol-attributable fractions
for HIV/AIDS mortality by SES, age and sex were calculated
based on the risk of engaging in condom-unprotected sex
under the influence of alcohol and interactions between SES
and alcohol use. Age-standardised HIV/AIDS mortality rates
attributable to alcohol by SES and sex were estimated using
alcohol-attributable fractions and SES-specific and sexspecific
death counts. Rate ratios were calculated comparing
age-standardised rates in low versus high SES by sex.
Results The age-standardised HIV/AIDS mortality rate
attributable to alcohol was 31.0 (95% uncertainty interval
(UI) 21.6 to 41.3) and 229.6 (95% UI 108.8 to 351.6)
deaths per 100 000 adults for men of high and low SES,
respectively. For women the respective rates were 10.8
(95% UI 5.5 to 16.1) and 75.5 (95% UI 31.2 to 144.9).
The rate ratio was 7.4 (95% UI 3.4 to 13.2) for men and
7.0 (95% UI 2.8 to 18.2) for women. Sensitivity analyses
corroborated marked differences in alcohol-attributable
HIV/AIDS mortality, with rate ratios between 2.7 (95% UI
0.8 to 7.6; women) and 15.1 (95% UI 6.8 to 27.7; men).
Conclusions The present study showed that alcohol
use contributed considerably to the socioeconomic
differences in HIV/AIDS mortality. Targeting HIV infection
under the influence of alcohol is a promising strategy for
interventions to reduce the HIV/AIDS burden and related
socioeconomic differences in South Africa.
Description
CITATION: Probst, C., Parry, C.D.H. & Rehm, J. 2018. HIV/AIDS mortality attributable to alcohol use in South Africa: a comparative risk assessment by socioeconomic status. BMJ Open 8(2):e017955. doi:10.1136/bmjopen-2017-017955.
The original publication is available at https://bmjopen.bmj.com/
The original publication is available at https://bmjopen.bmj.com/
Keywords
HIV, AIDS, Alcohol, Alcohol use, Adults, Socioeconomic status -- SES, South African adult general population
Citation
Probst, C., Parry, C.D.H. & Rehm, J. 2018. HIV/AIDS mortality attributable to alcohol use in South Africa: a comparative risk assessment by socioeconomic status. BMJ Open 8(2):e017955. doi:10.1136/bmjopen-2017-017955.