A Standardized Algorithm for Determining the Underlying Cause of Death in HIV Infection as AIDS or non-AIDS Related: Results from the EuroSIDA Study

TY - JOUR

T1 - A Standardized Algorithm for Determining the Underlying Cause of Death in HIV Infection as AIDS or non-AIDS Related: Results from the EuroSIDA Study

AU - Kowalska, Justyna D

AU - Mocroft, Amanda

AU - Ledergerber, Bruno

AU - Florence, Eric

AU - Ristola, Matti

AU - Begovac, Josip

AU - Sambatakou, Helen

AU - Pedersen, Court

AU - Lundgren, Jens D

AU - Kirk, Ole

AU - Eurosida Study Group

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Objectives: Analyzing changes in causes of death over time is essential for understanding the emerging trends in HIV population mortality, yet data on cause of death are often missing. This poses analytic limitations, as does the changing approach in data collection by longitudinal studies, which are a natural consequence of an increased awareness and knowledge in the field. To monitor and analyze changes in mortality over time, we have explored this issue within the EuroSIDA study and propose a standardized protocol unifying data collected and allowing for classification of all deaths as AIDS or non-AIDS related, including events with missing cause of death. Methods: Several classifications of the underlying cause of death as AIDS or non-AIDS related within the EuroSIDA study were compared: central classification (CC-reference group) based on an externally standardised method (the CoDe procedures), local cohort classification (LCC) as reported by the site investigator, and 4 algorithms (ALG) created based on survival times after specific AIDS events. Results: A total of 2,783 deaths occurred, 540 CoDe forms were collected, and 488 were used to evaluate agreements. The agreement between CC and LCC was substantial (κ = 0.7) and the agreement between CC and ALG was moderate (κ < 0.6). Consequently, a stepwise algorithm was derived prioritizing CC over LCC and, in patients with no information available, best-fit ALG. Using this algorithm, 1,332 (47.9%) deaths were classified as AIDS and 1,451 (52.1%) as non-AIDS related. Conclusions: Our proposed stepwise algorithm for classifying deaths provides a valuable tool for future research, however validation in another setting is warranted.

AB - Objectives: Analyzing changes in causes of death over time is essential for understanding the emerging trends in HIV population mortality, yet data on cause of death are often missing. This poses analytic limitations, as does the changing approach in data collection by longitudinal studies, which are a natural consequence of an increased awareness and knowledge in the field. To monitor and analyze changes in mortality over time, we have explored this issue within the EuroSIDA study and propose a standardized protocol unifying data collected and allowing for classification of all deaths as AIDS or non-AIDS related, including events with missing cause of death. Methods: Several classifications of the underlying cause of death as AIDS or non-AIDS related within the EuroSIDA study were compared: central classification (CC-reference group) based on an externally standardised method (the CoDe procedures), local cohort classification (LCC) as reported by the site investigator, and 4 algorithms (ALG) created based on survival times after specific AIDS events. Results: A total of 2,783 deaths occurred, 540 CoDe forms were collected, and 488 were used to evaluate agreements. The agreement between CC and LCC was substantial (κ = 0.7) and the agreement between CC and ALG was moderate (κ < 0.6). Consequently, a stepwise algorithm was derived prioritizing CC over LCC and, in patients with no information available, best-fit ALG. Using this algorithm, 1,332 (47.9%) deaths were classified as AIDS and 1,451 (52.1%) as non-AIDS related. Conclusions: Our proposed stepwise algorithm for classifying deaths provides a valuable tool for future research, however validation in another setting is warranted.

KW - Acquired Immunodeficiency Syndrome

KW - Algorithms

KW - CD4 Lymphocyte Count

KW - Cause of Death

KW - HIV-1

KW - Humans

KW - Prospective Studies

U2 - 10.1310/hct1202-109

DO - 10.1310/hct1202-109

M3 - Journal article

C2 - 21498154

SN - 1528-4336

VL - 12

SP - 109

EP - 117

JO - HIV Clinical Trials

JF - HIV Clinical Trials

IS - 2

ER -