Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems
Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to in...
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| Format: | Article |
| Idioma: | anglès |
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BMC Medicine
2025
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| Accés en línia: | https://repository.auw.edu.bd/handle/123456789/878 |
| _version_ | 1857448882593595392 |
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| author | Chowdhury, Mohiuddin Ahsanul Kabir |
| author_facet | Chowdhury, Mohiuddin Ahsanul Kabir |
| author_sort | Chowdhury, Mohiuddin Ahsanul Kabir |
| collection | institutional Repository |
| description | Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the
burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover
multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems
and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this
analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths
by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico.
Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual
country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression
model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of
Disease Study 2017.
Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest
and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for
women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of
study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative
inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were
concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns
reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45
years of age at the municipality level in Brazil, Colombia, and Mexico in 2017.
Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local
trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and
uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention
to support HIV-related care and reduce HIV-related deaths. |
| format | Article |
| id | 123456789-878 |
| institution | Asian University for Women |
| language | English |
| publishDate | 2025 |
| publisher | BMC Medicine |
| record_format | dspace |
| spelling | 123456789-8782026-02-18T06:15:02Z Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems Chowdhury, Mohiuddin Ahsanul Kabir HIV/AIDS, Latin America, HIV mortality, Vital registration, Small area estimation, Mapping, Spatial statistics Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths. 2025-07-31T06:22:44Z 2025-07-31T06:22:44Z 2021 Article https://repository.auw.edu.bd/handle/123456789/878 en application/pdf BMC Medicine |
| spellingShingle | HIV/AIDS, Latin America, HIV mortality, Vital registration, Small area estimation, Mapping, Spatial statistics Chowdhury, Mohiuddin Ahsanul Kabir Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems |
| title | Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems |
| title_full | Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems |
| title_fullStr | Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems |
| title_full_unstemmed | Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems |
| title_short | Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems |
| title_sort | mapping subnational hiv mortality in six latin american countries with incomplete vital registration systems |
| topic | HIV/AIDS, Latin America, HIV mortality, Vital registration, Small area estimation, Mapping, Spatial statistics |
| url | https://repository.auw.edu.bd/handle/123456789/878 |
| work_keys_str_mv | AT chowdhurymohiuddinahsanulkabir mappingsubnationalhivmortalityinsixlatinamericancountrieswithincompletevitalregistrationsystems |