Impacts of using different standard populations in calculating age-standardized death rates when age-specific death rates in the populations being compared do not have a consistent relationship: A cross-sectional population-based observational study on US state HIV death rates

Objective: To examine if the rankings of state HIV age-standardized death rates (ASDRs) changed if different standard population (SP) was used.

Design: A cross-sectional population-based observational study. Setting 36 states in the United States.

Participants: People died from 2015 to 2019.

Main outcome measures: State HIV ASDR using 4 SPs, namely WHO2000, US2000, US2mor020, and Eur2011–2030.

Results: The rankings of 19 states did not change when ASDRs were calculated using US2000 and US2020. Of the 17 states whose rankings changed, the rankings of 9 states calculated using US2000 were higher than those calculated using US2020; in 8 states, the rankings were lower. The states with the greatest changes in rankings between US2000 and US2020 were Kentucky (12th and 9th, respectively) and Massachusetts (8th and 11th, respectively).

Conclusions: State ASDRs calculated using the current official SP (US2000) weigh middle-age HIV death rates more heavily than older-age HIV death rates, resulting in lower ASDRs among states with higher older-age HIV death rates.

Methods
The data were extracted from CDC WONDER.