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Mortality in young adults in England and Wales: the impact of the HIV epidemic

Nylén, Gunnar*; Mortimer, Janet; Evans, Barry; Gill, Noël

Epidemiology and Social: Original Papers

Objective: To quantify the contribution of the HIV epidemic to premature mortality in England and Wales 1985-1996.

Design: Surveillance of deaths in HIV-infected individuals and causes of death from death certificates.

Main outcome measures: Time trends in age-specific mortality rates among 15-44 year olds and years of potential life lost (YPLL) to age 65 associated with HIV infection and other important causes of death in young adults.

Results: The crude age-specific mortality rates for all causes of death in the 15-44 year age band remained fairly constant between 1985 and 1996: in other age bands a decrease was seen. Deaths from both suicide and HIV increased in men aged 15-44 years. Although suicide accounted for a greater number of deaths throughout the period investigated, the largest proportional and absolute increase was seen for deaths in HIV-infected people. By 1996, the contribution of HIV to YPLL to age 65 varied from less than 0.5% in most rural localities to 20% of total YPLL in one London health authority.

Conclusions: While part of the adverse trend in mortality in younger adults since 1985 was attributable to suicide, most resulted from HIV infection. The impact of HIV infection on mortality was greatest in London.

From the PHLS AIDS and STD Centre, Communicable Diseases Surveillance Centre, London, UK. Present address Department of Infectious Diseases, Karolinska Institute, Stockholm, Sweden.

Sponsorship: G. Nylén was supported by the EPIET, European Programme for Intervention Epidemiology Training.

Requests for reprints to: Gunnar Nylén, Department of Infectious Diseases, Karolinska sjukhuset, SE-171 76 Stockholm, Sweden.

Received: 19 November 1998; revised: 29 April 1999; accepted: 13 May 1999.

© 1999 Lippincott Williams & Wilkins, Inc.