Mortality in migrants living with XXXX in western Europe (1997-2013): a collaborative cohort study.

@entity1 @entity645
BACKGROUND: Many migrants face adverse socioeconomic conditions and barriers to health services that can impair timely @entity645 diagnosis and access to life-saving treatments. We aimed to assess the differences in overall mortality by geographical origin in @entity645 -positive @entity1 and @entity1 using data from COHERE, a large European collaboration of @entity645 cohorts from 1997 to 2013. METHODS: In this observational cohort study, we included HIV-positive, antiretroviral-naive @entity1 accessing care in western Europe from COHERE. Individuals were eligible if enrolled in a cohort that collected information on geographical origin or ethnic origin from Jan 1, 1997, to March 19, 2013, aged 18-75 years, they had available information about sex, they were not infected perinatally or after the receipt of clotting factor concentrates, and were naive to combination antiretroviral therapy at cohort entry. Migrants' origins were grouped into seven regions: western Europe and similar countries (Australia, Canada, New Zealand, and the USA); eastern Europe; North Africa and the Middle East; sub-Saharan Africa; Latin America; the Caribbean; and Asia and the rest of Oceania (excluding Australia and New Zealand). Crude and adjusted mortality rate ratios were calculated by use of Poisson regression stratified by sex, comparing each group with the native population. Multiple imputation with chained equations was used to account for missing values. FINDINGS: Between Oct 25, 1979, and March 19, 2013, we recruited 279   659 individuals to the COHERE collaboration in EuroCoord. Of these 123   344 @entity1 and 45   877 @entity1 met the inclusion criteria. Our data suggested effect modification by transmission route (pinteraction=0  12 for @entity1 ; pinteraction=0  002 for @entity1 ). No significant difference in mortality was identified by geographical origin in @entity1 who have sex with @entity1 . In heterosexual populations, most migrant @entity1 had mortality lower than or equal to that of native @entity1 , whereas no group of migrant @entity1 had mortality lower than that in native @entity1 . High mortality was identified in heterosexual @entity1 from Latin America (rate ratio [RR] 1  46, 95% CI 1  00-2  12, p=0  049) and heterosexual @entity1 from the Caribbean (1  48, 1  29-1  70, p<0  0001). Compared with that in the native population, mortality in injecting drug users was similar or low for all migrant groups. INTERPRETATION: Characteristics of and risks faced by migrant populations with @entity645 differ for @entity1 and @entity1 and for populations infected heterosexually, by sex between @entity1 , or by injecting drug use. Further research is needed to understand how inequalities are generated and maintained for the groups with higher mortality identified in this study. FUNDING: EuroCoord.
