Hypertension is a marker of the microepidemiologic transition in ageing HIV populations in Kenya, Uganda and Tanzania (AFRICOS, 2013–2023)
1
Department of Population Studies, College of Business and Management Sciences, P.O. Box 7062, Makerere University, Uganda, Makerere University, Makerere, Uganda
2
School of Biodiversity, One Health and Veterinary Medicine, College of Medical, Veterinary and Life Sciences,, University of Glasgow, G12 8QQ, Glasgow, Glasgow, United Kingdom
3
Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan BP 1303, Côte d’Ivoire, Abidjan, Côte dIvoire
4
4National Institute for Medical Research, Muhimbili Medical Research Centre, P.O. Box 3436, Tanzania, Muhimbili, Tanzania, United Republic of
5
Makerere University Walter Reed Program (MUWRP), Kampala, Uganda
Popul. Med. 2026;8(Supplement Supplement 1):A2965
ABSTRACT
BACKGROUND:
Although mortality among people living with HIV (PLHIV) in sub-Saharan Africa has decreased markedly with increasing scale-up of antiretroviral therapy (ART), the demographic consequences of this success remain underexamined.
METHODS:
Using ten years of longitudinal data from the African Cohort Study (AFRICOS; 2013–2023) in Kenya, Tanzania, and Uganda, we estimated the association of hypertension with all-cause mortality among adults aged 40 years and older. We combined descriptive decremental life-table analysis with discrete-time logistic regression, applying both lagged and exponentially weighted moving-average (EWMA) exposure models.
RESULTS:
At baseline, 18.6% of the participants were hypertensive; 60.1% experienced hypertension during follow-up, and all-cause mortality was 6.4%. Life-table estimates revealed that cumulative excess mortality (Δqₓ) among hypertensive participants increased from 0.4% in the first interval to 4.4% by year nine. Excess mortality was greater among adults aged ≥50 years (Δqₓ ≈ 5.4% vs. 4.4% at ages 40–49), men (Δqₓ ≈ 8.0% vs. 2.8% in women), underweight participants (Δqₓ > 20% in early intervals), and those with high viral loads (Δqₓ ≈ 7.0%). In adjusted discrete-time models controlling for age, sex, body mass index, viral load, and country, hypertension was associated with higher mortality under a standard lag specification (aOR = 2.04; 95% CI 1.10–3.80) and under EWMA exposure definitions (aOR = 3.25; 95% CI 1.26–8.40 at α = 0.3; aOR = 2.51; 95% CI 1.16–5.44 at α = 0.7). Mortality odds were greater among participants aged ≥60 years (aOR = 2.23–2.40; 95% CI 0.85–6.16) and those with high viral loads (aOR = 2.36–2.44; 95% CI 1.28–4.51), whereas overweight and obese participants had substantially lower odds of death (aOR = 0.29; 95% CI 0.10–0.85 and aOR = 0.14; 95% CI 0.04–0.56).
CONCLUSIONS:
Hypertension has become a key driver of excess mortality and a demographic indicator of the region’s compressed health transition.
Although mortality among people living with HIV (PLHIV) in sub-Saharan Africa has decreased markedly with increasing scale-up of antiretroviral therapy (ART), the demographic consequences of this success remain underexamined.
METHODS:
Using ten years of longitudinal data from the African Cohort Study (AFRICOS; 2013–2023) in Kenya, Tanzania, and Uganda, we estimated the association of hypertension with all-cause mortality among adults aged 40 years and older. We combined descriptive decremental life-table analysis with discrete-time logistic regression, applying both lagged and exponentially weighted moving-average (EWMA) exposure models.
RESULTS:
At baseline, 18.6% of the participants were hypertensive; 60.1% experienced hypertension during follow-up, and all-cause mortality was 6.4%. Life-table estimates revealed that cumulative excess mortality (Δqₓ) among hypertensive participants increased from 0.4% in the first interval to 4.4% by year nine. Excess mortality was greater among adults aged ≥50 years (Δqₓ ≈ 5.4% vs. 4.4% at ages 40–49), men (Δqₓ ≈ 8.0% vs. 2.8% in women), underweight participants (Δqₓ > 20% in early intervals), and those with high viral loads (Δqₓ ≈ 7.0%). In adjusted discrete-time models controlling for age, sex, body mass index, viral load, and country, hypertension was associated with higher mortality under a standard lag specification (aOR = 2.04; 95% CI 1.10–3.80) and under EWMA exposure definitions (aOR = 3.25; 95% CI 1.26–8.40 at α = 0.3; aOR = 2.51; 95% CI 1.16–5.44 at α = 0.7). Mortality odds were greater among participants aged ≥60 years (aOR = 2.23–2.40; 95% CI 0.85–6.16) and those with high viral loads (aOR = 2.36–2.44; 95% CI 1.28–4.51), whereas overweight and obese participants had substantially lower odds of death (aOR = 0.29; 95% CI 0.10–0.85 and aOR = 0.14; 95% CI 0.04–0.56).
CONCLUSIONS:
Hypertension has become a key driver of excess mortality and a demographic indicator of the region’s compressed health transition.
| eISSN: | 2654-1459 |
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