Race, place and AIDS: the role of socioeconomic context on racial disparities in treatment and survival in San Francisco.
Race, place and AIDS: the role of socioeconomic context on racial disparities in treatment and survival in San Francisco.
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DOI：
10.1016/j.socscimed.2009.04.019
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发表时间：
2009-07-01
期刊：
影响因子：
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通讯作者：
Rutherford, George W
中科院分区：
文献类型：
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作者：
Arnold, Michael;Hsu, Ling;Rutherford, George W
先前的证据表明，抗逆转录病毒治疗（ART）对艾滋病患者（PLWAs）的健康和长寿益处在美国的种族/族裔群体中分布不均。值得注意的是，黑人PLWAs往往比他们的同行更糟糕。我们研究了旧金山社区社会经济背景对艾滋病治疗和生存的种族/民族差异的作用。研究对象包括1996年至2001年间被诊断患有艾滋病的4211名旧金山居民。2006年报告的生命状况。人口普查数据被用来定义收入、住房、人口、就业和教育等社区一级指标。Cox比例风险模型用于生存时间的多变量分析。与白人相比，黑人的死亡率风险比（HR）高出1.4倍，在考虑了ART的开始后，这一比例下降了。与种族/民族无关，社会经济水平最低的社区的PLWAs相对于社会经济水平较高的社区的HR为1.4。考虑到抗逆转录病毒治疗开始后，社区协会减少。通径分析用于探索抗逆转录病毒治疗开始的因果途径。社区居住的种族/民族差异占黑人-白人相对优势比（ROR） 1.6-1.8的19-22%，占拉丁裔-白人相对优势比（ROR） 1.3-1.4的14-15%。我们的研究结果阐明了种族和地域对治疗差异的独立和协同贡献，并强调了未来研究和干预的必要性，以解决治疗开始以及邻里对治疗差异的影响。
Prior evidence suggests that the health and longevity benefits of antiretroviral therapy (ART) for persons living with AIDS (PLWAs) have not been equally distributed across racial/ethnic groups in the United States. Notably, black PLWAs tend to fare worse than their counterparts. We examine the role of neighborhood socioeconomic context on racial/ethnic differences in AIDS treatment and survival in San Francisco. The study population encompassed 4211 San Francisco residents diagnosed with AIDS between 1996 and 2001. Vital status was reported through 2006. Census data were used to define neighborhood-level indicators of income, housing, demographics, employment and education. Cox proportional hazards models were employed in multivariate analyses of survival times. Compared to whites, blacks had a significant 1.4 greater mortality hazard ratio (HR), which decreased after accounting for ART initiation. PLWAs in the lowest socioeconomic neighborhoods had a significant HR of 1.4 relative to those in higher socioeconomic neighborhoods, independent of race/ethnicity. The neighborhood association decreased after accounting for ART initiation. Path analysis was used to explore causal pathways to ART initiation. Racial/ethnic differences in neighborhood residence accounted for 19-22% of the 1.6-1.8 black-white relative odds ratio (ROR) and 14-15% of the 1.3-1.4 Latino-white ROR for delayed or no treatment. Our findings illuminate the independent and synergistic contributions of race and place on treatment disparities and highlight the need for future studies and interventions to address treatment initiation as well as neighborhood effects on treatment differences.