County-Level Socioeconomic Status and Survival After HIV Diagnosis, United States
County-Level Socioeconomic Status and Survival After HIV Diagnosis, United States
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DOI：
10.1016/j.annepidem.2008.09.003
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发表时间：
2008-12-01
影响因子：
5.6
通讯作者：
Hall, H. Irene
中科院分区：
文献类型：
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作者：
Harrison, Kathleen McDavid;Ling, Qiang;Hall, H. Irene
目得：估计人类免疫缺陷病毒（HIV）诊断后的相对生存率（RS），通过种族/民族和县级社会经济地位（SES）方法：我们估计5年RS的年龄，种族/民族，传播类别，性别，诊断年，CD 4计数，并通过县级SES变量从美国人口普查。来自全国艾滋病毒/艾滋病报告系统的数据涉及13岁以上的艾滋病毒感染者（1996-2003年诊断，2005年随访）。我们使用最大似然算法计算RS比例，并使用广义线性模型对超额死亡的相对风险（RR）进行建模，将贫困作为随机效应。对男人来说，RS在生活在2000年美国贫困线以下的人口比例较大的县更糟（贫困率≥ 20%的为87.7%，贫困率< 5.0%的为90.1%），失业率较高（失业率> 7.1%的为87.8%，失业率< 4.0%的为90.5%）。县级社会经济地位对妇女社会支持度的影响相似。在多水平多变量模型中，在10.0-19.9%（与< 5.0%）生活在贫困线以下的县，艾滋病诊断后5年内男性和女性的RR显著更差（RR = 1.3 [95%CI 1.2-1.5]和RR = 1.8 [95%CI 1.4-2.2]）。为了帮助解决县级社会经济地位的影响，应将艾滋病毒检测、护理和经过验证的经济干预措施的资源用于经济弱势群体集中的地区。
PURPOSE: To estimate relative survival (RS) after human immunodeficiency virus (HIV) diagnosis, by race/ethnicity and county-level socioeconomic status (SES).METHODS: We estimated 5-year RS by age, race/ethnicity, transmission category, sex, diagnosis year, CD4 count, and by county-level SES variables from the U.S. Census. Data, from the national HIV/AIDS Reporting System, were for HIV-infected persons ages >= 13 years (diagnosis during 1996-2003 and follow-up through 2005). We calculated RS proportions by using a maximum likelihood algorithm and modeled the relative risk of excess death (RR) using generalized linear models, with poverty as a random effect.RESULTS: For men, RS was worse in Counties with larger proportions of people living below the 2000 U.S. poverty level (87.7% for poverty of >= 20% vs. 90.1% for poverty of < 5.0%) and where unemployment was greater (87.8% where unemployment > 7.1% vs. 90.5% where unemployment < 4.0%). The effects of county-level SES on RS of women were similar. In multilevel multivariate models, RR for men and women within 5 years after an HIV diagnosis was significantly worse in counties where 10.0-19.9% (compared with < 5.0%) lived below the poverty level (RR = 1.3 [95% CI 1.2-1.5] and RR = 1.8 [95% CI 1.4-2.2], respectively).CONCLUSIONS: RS was worse in lower SES areas. To help address the impact of county-level SES, resources for HIV testing, care, and proven economic interventions should be directed to areas with concentrations of economically disadvantaged people.