Trends in HIV-related mortality by sex, race, age, and region in the United States, 1999–2023

Although antiretroviral therapy has improved human immunodeficiency virus (HIV) prognosis, mortality and demographic disparities remain critical public health issues in the United States (US). This study analyzed long-term trends in HIV-related mortality from 1999 to 2023 using Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research data. This retrospective database study analyzed death certificate data for HIV-related deaths in the US from 1999 to 2023. Crude and age-adjusted mortality rates were calculated. Joinpoint regression was used to assess trends using annual percent change (APC) and average APC (AAPC), stratified by sex, race/ethnicity, age group, census region, and urbanization level. A total of 221,831 HIV-related deaths occurred from 1999 to 2023. Annual deaths declined from 14,499 in 1999 to 4719 in 2023, representing a 67.45% reduction. The age-adjusted mortality rate decreased from 8.05 to 1.92 per 100,000 population, with an AAPC of -5.73. The decline was fastest from 2007 to 2011 (APC = -10.99) but slowed from 2019 to 2023 (APC = -2.79). Mortality rates remained higher among men, non-Hispanic Black individuals, and residents of the Southern US. Although mortality declined in both metropolitan and nonmetropolitan areas, the decline was slower in nonmetropolitan areas than in metropolitan areas (AAPC = -3.92 vs -6.54). Mortality increased among older age groups, particularly those aged 75 to 84 years. HIV-related mortality in the US decreased substantially from 1999 to 2023, but the pace of decline slowed in recent years. Persistent racial, geographic, urban-rural, and age-related disparities highlight the need for targeted interventions, improved access to HIV care, and strategies addressing the growing burden among older adults.