Global, Regional, and National Burden, Trends, and Health Disparities of Older People Living With HIV From 1990 to 2021.

OBJECTIVE: Utilizing Global Burden of Disease Study (GBD 2021) data, this study aims to illustrate trends of older people living with HIV (PLHIV) from 1990 to 2021 and explore the phenomenon of health inequality. METHODS: This research extracted core indicators, including incidence, prevalence, deaths, and disability-adjusted life years (DALYs). The age-standardized rates (ASRs) for these measures were calculated. Decomposition analysis was employed to explore factors associated with PLHIV burden fluctuation. Inequality analysis and frontier analysis were applied to describe the temporal and spatial trends of the disease burden. RESULTS: The age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized deaths rate (ASDR), and age-standardized DALY rate were all at the highest levels in low SDI regions. Decomposition analysis uncovered epidemiological changes as the main driver of the global burden. In 2021, the heaviest burden was seen in the 50-69 age group in global and five SDI regions. Compared to 1990, the absolute value of the index of inequality (SII) decreased for ASIR in 2021 but increased for ASPR, ASDR, and age-standardized DALY rate. The absolute values of the concentration index (CI) of ASRs for all indicators showed a trend of gradual decrease from 1990 to 2021. Frontier analysis indicated that countries with higher effective difference (EF) are predominantly from sub-Saharan Africa. CONCLUSIONS: Compared to 1990, the disease burden of ASIR among older PLHIV decreased in 2021. Meanwhile, relative health inequality showed an improving trend. In high-burden areas, especially in sub-Saharan Africa, there is a need to adopt targeted public health strategies.