---
title: "Race, HIV, and In-Hospital Mortality for Pneumonia and Sepsis: A 2018–2021 Cohort Analysis"
id: "pubmed-42872795"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42872795"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42872795/"
doi: "10.1097/QAI.0000000000003987"
published_at: "2026-10-14T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Race, HIV, and In-Hospital Mortality for Pneumonia and Sepsis: A 2018–2021 Cohort Analysis
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42872795
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42872795/)
- **DOI:** [10.1097/QAI.0000000000003987](https://doi.org/10.1097%2FQAI.0000000000003987)
- **Published At:** 2026-10-14T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Investigators conducted a retrospective cohort study using the Healthcare Cost and Utilization Project State Inpatient Databases from seven U.S. states covering 2018–2021. The cohort comprised 3,949,906 hospitalizations for **pneumonia** and/or **sepsis**. - The team compared crude in-hospital mortality by **HIV** status and race, then used multilevel logistic regression models adjusted for demographics, comorbidities, acute organ failures present on admission, do-not-resuscitate status, surgical status, and hospital-level clustering. - A statistically significant HIV × race interaction was observed (P = 0.0033), indicating effect modification by race in the HIV–mortality relationship. - Crude mortality was lower among people with HIV (8.4%) than among patients without HIV (10.2%); the absolute risk difference was 1.8% (95% CI, 1.6–2.0). - After adjustment, **HIV** was associated with increased mortality among patients identified as White (adjusted odds ratio [aOR] 1.09; 95% CI, 1.03–1.16) and Asian (aOR 1.53; 95% CI, 1.13–2.08). - The adjusted association between HIV and mortality was not statistically significant among patients identified as Black or Other race; racial disparities also varied when analyzed separately by HIV status. - The authors argued that average population estimates mask heterogeneity across racial groups and suggested an intersectionality framework to explore structural mechanisms underlying disparities in critical illness among PWH. - The abstract reports study design, data source, adjustment covariates, main interaction test, sample size, crude mortality rates, and race-specific aORs; the source did not report additional patient-level demographic breakdowns, antiretroviral therapy status, or detailed clinical severity scores in the abstract.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Identifying disparities at the intersection of race and HIV in patients with sepsis and pneumonia [Gwenyth L Day](https://pubmed.ncbi.nlm.nih.gov/?term=Day+GL&cauthor_id=42872795)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42872795/#full-view-affiliation-1 "Division of Pulmonary Science and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045."), [Anuj B Mehta](https://pubmed.ncbi.nlm.nih.gov/?term=Mehta+AB&cauthor_id=42872795)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42872795/#full-view-affiliation-2 "Pulmonary and Critical Care Medicine, Denver Health and Hospital Authority, 777 Bannock St, Denver, CO 80204."), [Kristine M Erlandson](https://pubmed.ncbi.nlm.nih.gov/?term=Erlandson+KM&cauthor_id=42872795)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42872795/#full-view-affiliation-3 "Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045."), [Thomas S Valley](https://pubmed.ncbi.nlm.nih.gov/?term=Valley+TS&cauthor_id=42872795)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42872795/#full-view-affiliation-1 "Division of Pulmonary Science and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045."), [Joshua A Barocas](https://pubmed.ncbi.nlm.nih.gov/?term=Barocas+JA&cauthor_id=42872795)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42872795/#full-view-affiliation-3 "Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42872795/#full-view-affiliation-4 "Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045.") Affiliations Expand ### Affiliations * 1 Division of Pulmonary Science and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045. * 2 Pulmonary and Critical Care Medicine, Denver Health and Hospital Authority, 777 Bannock St, Denver, CO 80204. * 3 Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045. * 4 Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045. * PMID: **42872795** * DOI: [ 10.1097/QAI.0000000000003987 ](https://doi.org/10.1097/qai.0000000000003987) Item in Clipboard # Identifying disparities at the intersection of race and HIV in patients with sepsis and pneumonia Gwenyth L Day et al. J Acquir Immune Defic Syndr. 2026. Show details Display options Display options Format Abstract PubMed PMID J Acquir Immune Defic Syndr Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Acquir+Immune+Defic+Syndr%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Acquir+Immune+Defic+Syndr%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42872795/) . 2026 Oct 14. doi: 10.1097/QAI.0000000000003987. Online ahead of print. ### Authors [Gwenyth L Day](https://pubmed.ncbi.nlm.nih.gov/?term=Day+GL&cauthor_id=42872795)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42872795/#short-view-affiliation-1 "Division of Pulmonary Science and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045."), [Anuj B Mehta](https://pubmed.ncbi.nlm.nih.gov/?term=Mehta+AB&cauthor_id=42872795)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42872795/#short-view-affiliation-2 "Pulmonary and Critical Care Medicine, Denver Health and Hospital Authority, 777 Bannock St, Denver, CO 80204."), [Kristine M Erlandson](https://pubmed.ncbi.nlm.nih.gov/?term=Erlandson+KM&cauthor_id=42872795)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42872795/#short-view-affiliation-3 "Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045."), [Thomas S Valley](https://pubmed.ncbi.nlm.nih.gov/?term=Valley+TS&cauthor_id=42872795)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42872795/#short-view-affiliation-1 "Division of Pulmonary Science and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045."), [Joshua A Barocas](https://pubmed.ncbi.nlm.nih.gov/?term=Barocas+JA&cauthor_id=42872795)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42872795/#short-view-affiliation-3 "Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42872795/#short-view-affiliation-4 "Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045.") ### Affiliations * 1 Division of Pulmonary Science and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045. * 2 Pulmonary and Critical Care Medicine, Denver Health and Hospital Authority, 777 Bannock St, Denver, CO 80204. * 3 Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045. * 4 Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, 12700 E19th Ave, Aurora, CO 80045. * PMID: **42872795** * DOI: [ 10.1097/QAI.0000000000003987 ](https://doi.org/10.1097/qai.0000000000003987) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** Pneumonia and sepsis remain leading causes of hospitalization and death among people with HIV (PWH) despite widespread antiretroviral therapy. Although disparities in critical illness have been described, it remains unclear whether the association between HIV status and mortality differs across racial groups. **Setting:** Retrospective cohort study of adults hospitalized with pneumonia and/or sepsis using the Healthcare Cost and Utilization Project State Inpatient Databases from seven U.S. states (2018-2021). **Methods:** We compared crude in-hospital mortality by HIV status and race. Multilevel logistic regression models adjusted for demographics, comorbidities, acute organ failures present on admission, do-not-resuscitate status, surgical status, and hospital-level clustering. We evaluated race as an effect modifier using an HIV × race interaction model to estimate race-specific adjusted odds ratios. Complementary analyses evaluated racial disparities separately among patients with and without HIV. **Results:** Among 3,949,906 hospitalizations, PWH had lower crude mortality than patients without HIV (8.4% vs. 10.2%; absolute risk difference, 1.8%, 95% CI, 1.6-2.0). A significant HIV × race interaction was observed (P=0.0033). HIV infection was associated with increased mortality among patients identified as White (aOR, 1.09; 95% CI, 1.03-1.16) and Asian (aOR, 1.53; 95% CI, 1.13-2.08), but not among patients identified as Black or Other race. Racial disparities also differed according to HIV status. **Conclusions:** The association between HIV infection and pneumonia- and sepsis-related mortality differs across racial groups, indicating important heterogeneity masked by average population estimates. An intersectionality framework may provide insight into structural mechanisms underlying disparities in critical illness among PWH. **Keywords:** Health disparities; intersectionality; pneumonia; sepsis. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Conflicts of interest: The authors have no conflicting interests to disclose. 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