Relationship of Racial Residential Segregation to Newly Diagnosed Cases of HIV among Black Heterosexuals in US Metropolitan Areas, 2008-2015
Relationship of Racial Residential Segregation to Newly Diagnosed Cases of HIV among Black Heterosexuals in US Metropolitan Areas, 2008-2015
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DOI：
10.1007/s11524-018-0303-1
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发表时间：
2019-12-01
影响因子：
6.6
通讯作者：
Cooper, Hannah L. F.
中科院分区：
文献类型：
--
作者：
Ibragimov, Umedjon;Beane, Stephanie;Cooper, Hannah L. F.
社会科学和公共卫生文献认为，居住隔离是黑人异性恋者艾滋病毒负担较高的一个强有力的结构性决定因素，但经验证据有限。本研究的目的是首次测试种族隔离与2008-2015年美国95个大城市统计区黑人成年人和青少年中新诊断的异性恋获得性艾滋病病例之间的关系。我们使用Massey和Denton的黑人居民隔离指数来实施种族隔离（主要暴露）；结果是每10,000名黑人成年异性恋者中新诊断出艾滋病毒病例的比率。我们使用纵向（2008-2015）msa水平数据的多水平多元模型测试了隔离与这一结果的关系，控制了潜在的混杂因素和时间。所有协变量滞后1年，并以基线值为中心。我们初步探讨了教育、就业和贫困率不平等对焦点关系的中介作用。隔离与结果呈正相关：基线隔离降低一个标准差与新HIV诊断率降低16.2%相关；随着时间的推移，隔离降低一个标准差与结果降低4.6%相关。探索性中介分析表明，黑人/白人社会经济不平等可能中介隔离与艾滋病毒之间的关系。我们的研究表明，居住隔离可能是黑人异性恋中艾滋病毒的远端决定因素。研究结果进一步强调，需要解决隔离问题，将其作为减少艾滋病毒方面种族不平等的综合战略的一部分。
Social science and public health literature has framed residential segregation as a potent structural determinant of the higher HIV burden among black heterosexuals, but empirical evidence has been limited. The purpose of this study is to test, for the first time, the association between racial segregation and newly diagnosed heterosexually acquired HIV cases among black adults and adolescents in 95 large US metropolitan statistical areas (MSAs) in 2008-2015. We operationalized racial segregation (the main exposure) using Massey and Denton's isolation index for black residents; the outcome was the rate of newly diagnosed HIV cases per 10,000 black adult heterosexuals. We tested the relationship of segregation to this outcome using multilevelmultivariate models of longitudinal (2008-2015) MSA-level data, controlling for potential confounders and time. All covariates were lagged by 1 year and centered on baseline values. We preliminarily explored mediation of the focal relationship by inequalities in education, employment, and poverty rates. Segregation was positively associated with the outcome: a one standard deviation decrease in baseline isolation was associated with a 16.2% reduction in the rate of new HIV diagnoses; one standard deviation reduction in isolation over time was associated with 4.6% decrease in the outcome. Exploratory mediation analyses suggest that black/white socioeconomic inequality may mediate the relationship between segregation and HIV. Our study suggests that residential segregation may be a distal determinant of HIV among black heterosexuals. The findings further emphasize the need to address segregation as part of a comprehensive strategy to reduce racial inequities in HIV.