AIDS in China from 2004 to 2018: Incidence and Mortality Trends and Age-period-cohort Effect Analysis

Abstract

Background AIDS is a very hazardous infectious disease. The analysis of AIDS incidence and mortality trends and the age-period-cohort influence on them, may provide insights into the formulation of AIDS related prevention and control policies. Objective To assess AIDS incidence and mortality trends, and the impact of age, period and cohort on the incidence and mortality of AIDS in China from 2004 to 2018. Methods In March 2022, from the online direct reporting system of the Data-center of China Health Science, number of AIDS patients, AIDS incidence, number of patients dying of AIDS, AIDS mortality in China during 2004—2018 were extracted from the overall information during the period. The Joinpoint regression model was used to estimate the trend of AIDS incidence and mortality, and to calculate the annual percent change (APC) and average annual percent change (AAPC) . The age-period-cohort model was used to assess the influence of age, period and cohort on the trend of AIDS incidence and mortality. Results During the period from 2004 to 2018, the incidence of AIDS in China increased from 0.248 9/100 000 to 4.956 9/100 000, and AIDS mortality increased from 0.060 5/100 000 to 1.431 2/100 000. Joinpoint regression analysis revealed that the incidence and mortality of AIDS in China had an average annual increase of 22.70%〔95%CI (20.70%, 24.80%) 〕and 18.80%〔95%CI (12.10%, 25.90%) 〕in the period, respectively (P<0.05) . The age-period-cohort analysis indicated that age, period and cohort all affected AIDS incidence and mortality (P<0.05) . The temporal trend in age-specific AIDS incidence or mortality showed a J-shaped curve of growth. The AIDS incidence increased from 0.000 4/100 000 in 5-9-year-olds to 2 828.828 5/100 000 in 75-79-year-olds, and the AIDS mortality increased from 0.000 4 in 5-9-year-olds to 740.297 4 in 75-79-year-olds. With the passage of time, the risk of AIDS incidence and mortality increased gradually: compared with the rate ratio of AIDS incidence and mortality (RR=1.000 0) in 2009—2013, the RR of AIDS incidence increased from 0.315 6〔95%CI (0.277 2, 0.359 4) 〕during 2004—2008 to 2.024 4〔95%CI (1.877 1, 2.183 2) 〕during 2014—2018. The RR of AIDS mortality increased from 0.329 1〔95%CI (0.291 7, 0.371 3) 〕in the period 2004—2008 to 1.522 6 in the period 2014—2018. The later the cohort was born, the greater the risk of AIDS incidence and mortality: compared with the relative risk of AIDS incidence and mortality (RR=1.000 0) in 1969—1973 cohort, the RR of AIDS incidence increased from 0.000 1〔95%CI (0, 0.000 4) 〕in the 1929—1933 cohort to 471.385 3〔95%CI (118.524 3, 1 874.755 6) 〕in the 2009—2013 cohort; the RR for mortality increased from 0.000 1 〔95%CI (0, 0.000 6) 〕in the 1929—1933 cohort to 93.634 5〔95%CI (21.168 0, 414.182 4) 〕in the 2009—2013 cohort. Conclusion AIDS incidence and mortality were on the rise in China during 2004—2018. AIDS incidence and mortality increased with age, and the period and cohort effects on the risk of incidence and mortality increased. More efforts need to be made to strengthen AIDS prevention and treatment in middle-aged and elderly people.

Keywords

• acquired immuno-deficiency syndrome|incidence|mortality|burden of illness|trend analysis|age-period-cohort model