Black-white mortality from HIV in the United States before and after introduction of highly active antiretroviral therapy in 1996
Black-white mortality from HIV in the United States before and after introduction of highly active antiretroviral therapy in 1996
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DOI：
10.2105/ajph.2005.081489
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发表时间：
2007-10-01
影响因子：
12.7
通讯作者：
Rust, George S.
中科院分区：
文献类型：
--
作者：
Levine, Robert S.;Briggs, Nathaniel C.;Rust, George S.
目标.我们试图描述在引入高效抗逆转录病毒治疗（HAART）前后HIV疾病死亡率的黑白差异。艾滋病毒造成的黑人-白人死亡率是针对全国的。我们进行了回归分析，以预测县级死亡率为25 - 84岁的黑人男性和相应的黑人：白色男性死亡率比（差距），在140个县，可靠的黑人死亡率为1999年至2002年。在采用高效抗逆转录病毒疗法后，全国黑人和白人之间的差距显著扩大，特别是在妇女和老年人中。在县回归分析中，在我们控制了黑人人口百分比和西班牙裔人口百分比后，背景社会经济地位（SES）不是黑人：白色死亡率比率的显著预测因子，在我们控制了HAART前死亡率后，背景SES和种族/民族都不是显著预测因子。背景SES、种族和HAART前死亡率都是黑人男性死亡率的重要和独立预测因素。虽然几乎所有的黑人群体都经历了HAART后的差距扩大，但差距并不是不可避免的，往往反映了HAART前的水平。公共卫生政策制定者应该考虑HAART创新的不平等扩散假设，地方效应使一些社区比其他社区更容易受到这一潜在问题的影响。
Objectives. We sought to describe Black-White differences in HIV disease mortality before and after the introduction of highly active antiretroviral treatment (HAART).Methods. Black-White mortality from HIV is described for the nation as a whole. We performed regression analyses to predict county-level mortality for Black men aged 25-84 years and the corresponding Black:White male mortality ratios (disparities) in 140 counties with reliable Black mortality for 1999-2002.Results. National Black-White disparities widened significantly after the introduction of HAART, especially among women and the elderly. In county regression analyses, contextual socioeconomic status (SES) was not a significant predictor of Black:White mortality rate ratio after we controlled for percentage of the population who were Black and percentage of the population who were Hispanic, and neither contextual SES nor race/ethnicity were significant predictors after we controlled for pre-HAART mortality. Contextual SES, race, and pre-HAART mortality were all significant and independent predictors of mortality among Black men.Conclusions. Although nearly all segments of the Black population experienced widened post-HAART disparities, disparities were not inevitable and tended to reflect pre-HAART levels. Public health policyrnakers should consider the hypothesis of unequal diffusion of the HAART innovation, with place effects rendering some communities more vulnerable than others to this potential problem.