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

Objective: To quantify the contribution of the HIV epidemic to premature mo rtality in England and Wales 1985-1996. Design: Surveillance of deaths in HIV-infected individuals and causes of de ath 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 incre ased in men aged 15-44 years. Although suicide accounted for a greater numb er of deaths throughout the period investigated, the largest proportional a nd absolute increase was seen for deaths in HIV-infected people. By 1996, t he 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. (C) 1999 L ippincott Williams & Wilkins.