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]

Coasts, West Scotland, United Kingdom, 1800 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: The Lewis and west coast of Scotland : from the best authorities, by Stuart Amos Arnold, and other experienced navigators. It was published by D. & E. Steele, at the Navigation Warehouse, Little Tower Hill in Jany. 1st, 1800. Scale [1:275,000]. The image inside the map neatline is georeferenced to the surface of the earth and fit to the Europe Lambert Conformal Conic coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, shoreline features (rocks, shoals, anchorage points, ports, inlets, etc.), and more. Relief shown by hachures and pictorially; depths shown by soundings. Includes index.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

Balkan Peninsula Region, 1800 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Charte vom Türkischen Reiche in Europa : nach den neuesten astronomischen Ortsbestim[m]ungen entworfen und berichtiget auf der Sternwarte Seeberg bey Gotha, gezeichnet von I. C. M. Reinecke. It was published by Verlag des Industrie-Comptoirs in 1800. Scale [ca. 1:3,500,000]. Covers the Balkan Peninsula region. Map in German.The image inside the map neatline is georeferenced to the surface of the earth and fit to the Europe Lambert Conformal Conic coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, territorial boundaries, shoreline features, and more. Relief shown by hachures.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

Empire de la Porte ottomane en Europe, en Asie et en Afrique avec les pays qui lui sont tributaires

dressé par les Frères Lotter.

The Turkish Empire in Europe, Asia, and Africa: dividid into all its governments, together with the other territories that are tributary to it, as also the dominions of ye Emperor of Marocco [sic] according to the newest and most exact observations

by H. Moll.

Turquie d'Europe et partie de celle d'Asie divisée par grandes provinces et gouvernemts

dressée sur les observations astronomiq. par le Sr. Janvier, geographe.