Burden of chronic comorbidities among people living with and without HIV in British Columbia, Canada : an epidemiological assessment of aging with HIV
Bibliographic record
Abstract
Background: The complex process of aging with HIV presents unique challenges, manifested, among others, as an increased risk of chronic comorbidities and, in turn, poor health outcomes among people living with HIV (PLWH). Utilizing large-scale administrative health data, this dissertation aimed to comprehensively examine, at the population-level, the burden of nine common chronic comorbidities as an indicator of aging among PLWH compared to age-sex-matched HIV-negative controls in British Columbia, Canada. This dissertation sought to develop a methodology to improve the reliability of prevalence and incidence estimates produced from administrative data research. Methods: Longitudinal individual-level data were obtained from linked provincial datasets established for Comparative Outcomes And Service Utilization Trends Study, a population-based cohort. We first assessed the critical but understudied impact of lookback windows (LWs), a retrospective period to ascertain diagnoses within administrative data, on prevalence and incidence of chronic comorbidities. Among PLWH and HIV-negative controls, we then examined various measures of disease burden during 2001-2012: annual prevalence trends and age at diagnosis of different comorbidities, multimorbidity and associated mortality, and disability-adjusted life years (DALYs), a measure of disease burden considering both mortality and morbidity. Results: The impact of LWs was comorbidity- and population-specific, with shorter LWs resulting in higher misclassification of prevalent and incidence cases. Compared to HIV-negative controls, for most comorbidities, PLWH experienced elevated prevalence, up to 10 times higher for liver diseases, and earlier age at diagnosis, up to 12.5 years earlier for non-HIV-related dementia. Prevalence of multimorbidity was double among PLWH, with those from rural regions experiencing higher excess associated mortality. Driven by premature mortality due to non-AIDS-defining cancers, PLWH also experienced twofold higher DALYs associated with chronic comorbidities. Conclusions: This dissertation contributes population-level evidence on the disproportionate burden of chronic comorbidities experienced by PLWH as they age. As aging shapes healthcare needs, our findings support optimized screening for comorbidities at earlier ages among PLWH and an HIV care model that integrates prevention and treatment of chronic comorbidities. Additionally, data-driven approaches proposed in this dissertation, which inform LW choices and address concerns on the growing use of administrative data for research, are reproducible to other settings.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.008 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".