The Silver Tsunami: Projecting multimorbidity, polypharmacy,and healthcare costs for those aging with HIV in the US

 描述(由申请人提供)：由于有效的治疗，美国艾滋病毒携带者和获得护理(PLWHC)的人现在的预期寿命接近普通人口。在普通民众中，二战后婴儿潮引发的人口泡沫被称为“银色海啸”。该项目的目标是填补对即将到来的PLWHC银色海啸的更详细、基于数据的预测的关键空白，以便更好地为政府和私人医疗系统的资源分配提供信息，并确定节省的目标。考虑到影响美国PLWHC年龄分布的因素，我们将使用模拟模型来预测到2030年的年龄分布，以回答这样一个问题：美国PLWHC预计的年龄分布是什么样子的？为了有用，数据需要按重要的人口统计(性别和种族)和地理特征进行分类。艾滋病毒感染已被证明会增加患胰岛素抵抗、慢性肾脏疾病、心肌梗死、终末期肾脏疾病和癌症的风险。将多发病和多药联用纳入预计年龄分布将回答：“多病和多药联用在老年艾滋病毒携带者中的预计负担是多少？”通过仔细的、基于数据的分析得出的信息将有很多用处，其中包括PLWHC中多病和多药的负担。我们建议将重点放在医疗费用这一重要问题上，因为与未感染艾滋病毒的成年人相比，老年艾滋病毒携带者的费用可能会增加。通过调查“照顾成年艾滋病毒携带者要花多少钱？”卫生系统以及州和联邦预算可以开始为艾滋病毒相关和非艾滋病毒相关成本做准备，并确定潜在成本节约的目标。我们组建了一个世界级的合作团队，结合了高质量的纵向数据、流行病学专业知识、北美艾滋病队列研究与设计协作(NA-ACCORD)的科学领导者，以及预防艾滋病并发症成本效益(CEPAC)团队在艾滋病毒疾病和医疗成本建模方面的领导者，以实现以下目标：目标1：通过预测到2030年美国PLWHC的年龄特定比例来填补知识空白，并根据重要的人口和地理亚群进行估计。目标2：预计到2030年，美国PLWHC中的多病和多药负担。目标3：预测到2030年美国PLWHC的非艾滋病毒相关医疗保健的年度成本。拟议的目标与2016年跨国立卫生研究院艾滋病毒相关研究计划和国立卫生研究院艾滋病毒/艾滋病研究优先事项和确定艾滋病资金的指导方针非常一致。研究结果将提供关键的艾滋病毒流行病学和卫生服务数据，这些数据对于指导研究重点、提高临床管理中对多种疾病和多药并存的认识以及为卫生系统的资源分配提供信息是必要的。

 DESCRIPTION (provided by applicant): Due to effective treatment, persons living with HIV and accessing care (PLWHC) in the United States (US) now have a life expectancy approaching the general population. In the general population, the population bubble caused by the post-WWII Baby Boom has been referred to as the "Silver Tsunami." The goal of this project is to fill a vital gap for a more detailed, data-based projection of the imminent PLWHC Silver Tsunami to better inform allocation of resources in governmental and private healthcare systems and to identify targets for savings. Taking into account factors that affect the age distribution of PLWHC in the US, we will use simulation models to project the age distribution through 2030 to answer the question: "What does the projected age distribution of PLWHC in the US look like?" To be useful, data need to be disaggregated by important demographic (sex and race) and geographical characteristics. HIV infection has been shown to increase the risk of insulin resistance, chronic kidney disease, myocardial infarction, end-stage renal disease, and cancer. Incorporating multimorbidity and polypharmacy into the projected age distribution will answer: "What is the projected burden of multimorbidity and polypharmacy in adults aging with HIV?" Information derived by a careful, data-based analysis that includes the burden of multimorbidity and polypharmacy in PLWHC will have many uses. We propose to focus on the important issue of healthcare costs as it is likely that costs will be compounded in adults aging with HIV as compared to those without HIV. By investigating the question "How much will it cost to care for adults aging with HIV?" health systems and state and federal budgets can begin to prepare for both HIV-related and non-HIV-related costs and identify targets for potential cost savings. We have assembled a world-class collaboration that combines high-quality longitudinal data, epidemiological expertise, the scientific leaders of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), and the leaders in modeling of HIV disease and healthcare costs from the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) team to achieve the following aims: AIM 1: To fill the gap in knowledge by projecting age-specific proportions of PLWHC in the US through 2030, with estimates tailored to important demographic and geographic sub-groups. AIM 2: To project the burden of multimorbidity and polypharmacy among PLWHC in the US through 2030. AIM 3: To project the annual costs of non-HIV-related healthcare for PLWHC in the US through 2030. The proposed aims align well with the research priorities of the 2016 Trans-NIH Plan for HIV-Related Research and the NIH HIV/AIDS Research Priorities and Guidelines for Determining AIDS Funding. Findings will provide key HIV epidemiologic and health services data that are necessary for guiding research priorities, increasing awareness of multimorbidity and polypharmacy in clinical management, and informing health systems resource allocations.