Influence of Geographical Origin and Ethnicity on Mortality in Patients on Antiretroviral Therapy in Canada, Europe, and the United States

Our objective was to assess differences in all-cause mortality, as well as AIDS and non-AIDS death rates, among patients started on antiretroviral therapy (ART) according to their geographical origin and ethnicity/race in Europe, Canada, and the United States. METHODS: This was a collaboration of 19 cohort studies of human immunodeficiency virus-positive subjects who have initiated ART (ART Cohort Collaboration) between 1998 and 2009. Adjusted mortality hazard ratios (AHRs) were estimated using Cox regression. A competing risk framework was used to estimate adjusted subdistribution hazard ratios for AIDS and non-AIDS mortality. RESULTS: Of 46 648 European patients, 16.3% were from sub-Saharan Africa (SSA), 5.1% Caribbean and Latin America, 1.6% North Africa and Middle East, and 1.7% Asia/West; of 1371 patients from Canada, 14.9% were First Nations and 22.4% migrants, and of 7742 patients from North America, 55.5% were African American and 6.6% Hispanic. Migrants from SSA (AHR, 0.79; 95% confidence interval [CI], .68-.92) and Asia/West (AHR, 0.62; 95% CI, .41-.92) had lower mortality than Europeans; these differences appeared mainly attributable to lower non-AIDS mortality. Compared with white Canadians, mortality in Canadian First Nations people (AHR, 1.48; 95% CI, .96-2.29) was higher, both for AIDS and non-AIDS mortality rates. Among US patients, when compared with whites, African Americans had higher AIDS and non-AIDS mortality, and hazard ratios for all-cause mortality increased with time on ART. CONCLUSIONS: The lower mortality observed in migrants suggests "healthy migrant" effects, whereas the higher mortality in First Nations people and African Americans in North America suggests social inequality gaps. KEYWORDS: HIV infection, antiretroviral therapy, ethnic minorities, migrants Comment in Addressing disparities in HIV mortality: antiretroviral therapy is necessary but not sufficient. [Clin Infect Dis. 2013]

Characteristics and changes of thermokarst lakes in Canada, Russia and Sweden

Peat plateaus are widespread at high northern latitudes and are important soil organic carbon reservoirs. A warming climate can cause either increased ground subsidence (thermokarst) resulting in lake formation or increased drainage as the permafrost thaws. A better understanding of spatiotemporal variations in these landforms in relation to climate change is important for predicting the future thawing permafrost carbon feedback. In this study, dynamics in thermokarst lake extent during the last 35-50 years has been quantified through time series analysis of aerial photographs and high-resolution satellite images (IKONOS/QuickBird) in three peat plateau complexes, spread out across the northern circumpolar region along a climatic and permafrost gradient. From the mid-1970s until the mid-2000s there has been an increase in mean annual air temperature, winter precipitation, and ground temperature in all three study areas. The two peat plateaus located in the continuous and discontinuous permafrost zones, respectively, where mean annual air temperatures are below -5°C and ground temperatures are -2°C or colder, have experienced small changes in thermokarst lake extent. In the peat plateau located in the sporadic permafrost zone where the mean annual air temperature is around -3°C, and the ground temperature is close to 0°C, lake drainage and infilling with fen vegetation has been extensive and many new thermokarst lakes have formed. In a future progressively warmer and wetter climate permafrost degradation can cause significant impacts on landscape composition and greenhouse gas exchange also in areas with extensive peat plateaus, which presently still experience stable permafrost conditions.