Years gained, health lost? A population-based cohort study of sex differences in healthy life expectancy among people living with HIV.

Abstract

To assess sex differences in three measures of healthy life expectancy (HLE) among people living with HIV (PLWH) in British Columbia (BC), Canada, between 1996 and 2020. Retrospective population-based cohort study. BC, Canada, using the Comparative Outcomes and Service Utilisation Trends (COAST) cohort, derived from linked population-based administrative health datasets within a universal healthcare system. All known PLWH identified in COAST between 1996 and 2020. Of these, 2511 (17.8%) females and 11 624 (82.2%) males met inclusion criteria of age ≥20 years with ≥1 day of follow-up. HLE at ages 20, 40 and 55, estimated using Sullivan's abridged life table approach, integrating age-specific mortality rates with health condition prevalence. HLE was measured in three ways: age-related condition-free life expectancy (LE), multimorbidity-free (≥3 conditions) LE and mental health condition-free LE. All three HLE measures increased over time but remained higher among males than females across nearly all comparisons. Years lived with ≥1 condition, multimorbidity and mental health conditions also increased over time. In the most recent period (2012-2020), age-related condition-free LE was higher among males than females by 4.2, 2.4 and 0.2 years; multimorbidity-free LE by 7.2, 5.6 and 3.6 years; and mental health condition-free LE by 10.0, 6.8 and 4.2 years at ages 20, 40 and 55, respectively. Among PLWH within a universal healthcare system, gains in longevity have been accompanied by an increasing burden of chronic and mental health conditions. Females experience shorter HLE than males and lose more years to age-related multimorbidity and mental health conditions. These findings highlight the need for sex-responsive strategies to prevent and manage chronic and mental health conditions to ensure gains in LE translate into equitable healthy ageing among PLWH.