Anjali Sharma1, Donald R Hoover2, Qiuhu Shi3, Susan Holman4, Michael W Plankey5, Phyllis C Tien6,7, Kathleen M Weber8, Michelle Floris-Moore9, Hector H Bolivar10, David E Vance11, Elizabeth T Golub12, Marcia McDonnell Holstad13, Michael T Yin14. 1. Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA. 2. Department of Statistics and Biostatistics, Rutgers University, Piscataway, NJ, USA. 3. Department of Epidemiology and Community Health, New York Medical College, Valhalla, NY, USA. 4. Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA. 5. Department of Medicine, Georgetown University Medical Center, Washington, DC, USA. 6. Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA. 7. Department of Medicine, University of California San Francisco, San Francisco, CA, USA. 8. Department of Medicine, Cook County Health and Hospitals System/Hektoen Institute of Medicine, Chicago, IL, USA. 9. Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. 10. Department of Medicine, University of Miami Health System, Miami, FL, USA. 11. School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA. 12. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 13. Office of Academic Advancement, Emory School of Nursing, Atlanta, GA, USA. 14. Department of Medicine, Columbia University Medical Center, New York, NY, USA.
Abstract
BACKGROUND: Although fracture rates are higher in HIV+ than HIV- women, whether HIV infection increases risk of falls is unclear. We determined the longitudinal occurrence and risk factors for falls in the Women's Interagency HIV Study (WIHS), and explored associations with cognitive complaints. METHODS: Recent (prior 6 months) self-reported falls were collected in 1,816 (1,250 HIV+; 566 HIV-) women over 24 months. Generalized estimating equation models using stepwise selection determined odds of any fall (versus none). RESULTS: HIV+ women were older than HIV- women (median 49 versus 47 years; P=0.0004), more likely to report neuropathy (20% versus 16%; P=0.023), and had greater central nervous system (CNS) medication use. At least one fall was reported in 41% HIV+ versus 42% HIV- women, including ≥2 falls in 25% HIV+ and 24% HIV- (overall P=0.30). Cognitive complaints were associated with falls among HIV+ (odds ratio [OR] 2.38; 95% CI 1.83, 3.09) and HIV- women (OR 3.43; 95% CI 2.37, 4.97); in adjusted models, cognitive complaints remained significant only in HIV- women (adjusted [aOR] 2.26; 95% CI 1.46, 3.48). Factors associated with any fall in adjusted analyses included: depressive symptoms and neuropathy (both HIV+ and HIV-); age, marijuana use, multiple CNS medications, and HCV infection (HIV+ only); and cognitive complaints, quality of life, hypertension and obesity (HIV- only). CONCLUSIONS: Middle-aged HIV+ and HIV- women had similar fall rates. Among HIV+ women, factors affecting cognition such as age, depressive symptoms, marijuana use and multiple CNS medications were important predictors of falls, however, cognitive complaints were not.
BACKGROUND: Although fracture rates are higher in HIV+ than HIV- women, whether HIV infection increases risk of falls is unclear. We determined the longitudinal occurrence and risk factors for falls in the Women's Interagency HIV Study (WIHS), and explored associations with cognitive complaints. METHODS: Recent (prior 6 months) self-reported falls were collected in 1,816 (1,250 HIV+; 566 HIV-) women over 24 months. Generalized estimating equation models using stepwise selection determined odds of any fall (versus none). RESULTS: HIV+ women were older than HIV- women (median 49 versus 47 years; P=0.0004), more likely to report neuropathy (20% versus 16%; P=0.023), and had greater central nervous system (CNS) medication use. At least one fall was reported in 41% HIV+ versus 42% HIV- women, including ≥2 falls in 25% HIV+ and 24% HIV- (overall P=0.30). Cognitive complaints were associated with falls among HIV+ (odds ratio [OR] 2.38; 95% CI 1.83, 3.09) and HIV- women (OR 3.43; 95% CI 2.37, 4.97); in adjusted models, cognitive complaints remained significant only in HIV- women (adjusted [aOR] 2.26; 95% CI 1.46, 3.48). Factors associated with any fall in adjusted analyses included: depressive symptoms and neuropathy (both HIV+ and HIV-); age, marijuana use, multiple CNS medications, and HCV infection (HIV+ only); and cognitive complaints, quality of life, hypertension and obesity (HIV- only). CONCLUSIONS: Middle-aged HIV+ and HIV- women had similar fall rates. Among HIV+ women, factors affecting cognition such as age, depressive symptoms, marijuana use and multiple CNS medications were important predictors of falls, however, cognitive complaints were not.
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