AIDS incidence rates in Europe and the United States

Objective: To facilitate the quantitative comparison of AIDS incidence statistics between countries and with other diseases using statistics based on age-standardized incidence rates instead of absolute number of cases. Design: AIDS incidence rates for 19 countries belonging to the World Health Organization (WHO) European region, and for comparative purposes, the United States. Methods: Incidence rates were standardized using the world standard population for all ages, from 1985 to 1992. The data were derived from the WHO European Non-Aggregate AIDS Dataset and the Centers for Disease Control and Prevention (CDC) AIDS Public Information Dataset, adjusted for reporting delays in each country. Results: The AIDS incidence rate for men (81 in 1 000 000) in the United States was fourfold higher than the highest rate in a European country (Switzerland) in 1985; incidence rates in all other European countries, except France and Denmark, were below 10 in 1 000 000. Subsequently, AIDS incidence has increased more rapidly in southern Europe than in the rest of the continent. The estimated incidence rate for men in Spain (243 in 1 000 000) approached that in the United States (304 in 1 000 000) in 1992, and three additional countries (France, Switzerland and Italy) showed rates above 100 per million. The spread of the AIDS epidemic among women in some southern European countries was faster than in the United States. In Switzerland and Spain the standardized incidence rates in women were higher than in the United States by 1988 and 1992, respectively. Conclusions: Analysing trends in incidence rates avoids some weaknesses of AIDS statistics based on absolute numbers, and should become one of the standard tools for AIDS surveillance.