Individual and community-level effects in the socioeconomic inequalities of AIDS-related mortality in an urban area of southern Europe
Individual and community-level effects in the socioeconomic inequalities of AIDS-related mortality in an urban area of southern Europe
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DOI：
10.1136/jech.2006.048017
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发表时间：
2007-03-01
影响因子：
6.3
通讯作者：
Borrell, Carme
中科院分区：
文献类型：
--
作者：
Mari-Dell'Olmo, Marc;Rodriguez-Sanz, Maica;Borrell, Carme
目的：研究西班牙巴塞罗那 1991 - 6 年间（高效抗逆转录病毒疗法 (HAART) 之前）和 1997 - 2001 年（HAART 后）期间艾滋病死亡率的社会经济不平等，考虑到社会经济水平对个人和社区的影响。设计：横断面设计。地点：西班牙巴塞罗那。参与者：所有年龄 >= 20 岁的居民。对 1991 年至 2001 年间发生的所有与艾滋病相关的死亡进行了研究。分析的个体变量包括年龄、性别、教育水平、居住社区和艾滋病毒传播群体。男性失业率被用作社区层面邻里贫困的指标。拟合多水平泊松回归模型来估计艾滋病死亡率与个人和社区水平变量之间的关系。结果：在个人水平上，两个时期教育水平较低的静脉吸毒者（IDU）的艾滋病死亡相对风险（RR）较高。对于较年轻的人群，在HAART之前，与受教育程度较低相比，受过初等教育或以上教育的艾滋病相关死亡率，男性为4.7（95% CI 3.6至6.1），女性为5.2（95% CI 3.6至7.7），男性为4.7（95% CI 2.7至8.1），男性为4.5（95% CI 1.4至7.7）。 14.1）在HAART后时期的女性中。在社区层面，发现了艾滋病死亡率的区域效应，这种效应在两个时期的贫困程度较高的社区中更为重要，尽管这种效应在HAART后时期最为重要。结论：本研究表明，在HAART前和HAART后时期，艾滋病死亡率在个人变量和社区层面变量方面存在不平等。在实施预防和治疗策略时，必须考虑艾滋病死亡率的这些社会经济不平等。
Objective: To study socioeconomic inequalities in AIDS mortality in Barcelona, Spain, during the periods 1991 - 6 (before highly active antiretroviral therapy (HAART)) and 1997 - 2001 (post- HAART) taking into account individual as well as community effects of socioeconomic level.Design: Cross-sectional design.Setting: Barcelona, Spain.Participants: All residents aged >= 20 years. All AIDS-related deaths occurring between 1991 and 2001 were studied. The individual variables analysed were age, sex, educational level, neighbourhood of residence and HIV transmission group. Male unemployment was used as the community-level indicator of neighbourhood deprivation. Multilevel Poisson regression models were fitted to estimate the relationship between AIDS mortality and the individual- and community-level variables.Results: At the individual level, AIDS mortality relative risks (RR) were higher among intravenous drug users (IDUs) with lower educational level in both periods. For the younger population, the RR of AIDS-related mortality associated with having little education compared with having a primary education or more was 4.7 (95% CI 3.6 to 6.1) in men and 5.2 (95% CI 3.6 to 7.7) in women in the pre-HAART period, and 4.7 (95% CI 2.7 to 8.1) in men and 4.5 (95% CI 1.4 to 14.1) in women in the post- HAART period. At the community level, an area effect in AIDS mortality was found, which was more important in neighbourhoods having high deprivation in both periods, although the effect was most important in the post- HAART period.Conclusions: This study has shown inequalities in AIDS mortality in terms of both individual variables and a community-level variable in the pre-HAART as well as in the post- HAART period. These socioeconomic inequalities of AIDS mortality must be considered when prevention and treatment strategies are implemented.