Retrospective cohort study of racial disparities in HIV survival, Florida

描述（由申请人提供）：非洲裔美国人没有从人类免疫缺陷病毒（HIV）感染的生存改善中获益，其程度与非西班牙裔白人相同。感染艾滋病毒的非裔美国人的存活率大大低于非西班牙裔白人。我们的目标是估计社区剥夺，隔离和农村居住的背景因素在解释非洲裔美国人的生存劣势的作用，并描述在何种程度上的因素之间的变化与获得性免疫缺陷综合征（AIDS）的诊断时间和死亡。我们有五个具体目标：1）估计社区一级的剥夺和农村居住对艾滋病毒生存率的种族差异的影响; 2）估计种族隔离对艾滋病毒生存率的影响; 3）描述艾滋病诊断和死亡之间社区一级社会经济地位的变化; 4）比较艾滋病诊断和死亡之间社区种族隔离的程度; 5）描述艾滋病诊断与死亡之间农村向城市迁移的模式和预测因素。我们将对1993-2006年诊断为艾滋病的佛罗里达居民进行回顾性队列研究。来自佛罗里达卫生部艾滋病毒/艾滋病报告系统的监测记录将与佛罗里达生命记录和国家死亡指数记录相匹配，以确定生存状况。监测记录将与来自2000年美国人口普查的邮政编码级社会经济数据和城市级隔离指数以及来自卫生资源和服务管理区资源文件的县级卫生保健资源和农村/城市分类数据合并。将使用考克斯比例风险和多水平模型进行生存分析。更好地了解与非裔美国人生存率下降相关的背景因素的贡献，可以为指导干预研究和政策变化以提高非裔美国人的生存率奠定必要的基础。这支持了国家少数民族健康和健康差异中心的使命，即“减少并最终消除健康差异”。"

DESCRIPTION (provided by the applicant): African Americans have not benefited from improved survival with human immunodeficiency virus (HIV) infection to the same extent as non-Hispanic whites. Survival among African Americans infected with HIV is substantially lower than that among non-Hispanic whites. Our goal is to estimate the role of the contextual factors of community deprivation, segregation, and rural residence in explaining the survival disadvantage of African Americans and characterize the extent to which the factors change between the time of diagnosis with acquired immune deficiency syndrome (AIDS) and death. We have five specific aims: 1) estimate the effect of community-level deprivation and rural residence on racial disparities in HIV survival over time; 2) estimate the effect of racial segregation on HIV survival; 3) characterize changes in community-level socioeconomic status between the time of AIDS diagnosis and death; 4) compare the degree of community racial segregation between the time of AIDS diagnosis and death; and 5) characterize patterns and predictors of rural to urban migration between AIDS diagnosis and death. We will be conducting a retrospective cohort study of Florida residents diagnosed with AIDS from 1993-2006. Surveillance records from the Florida Department of Health HIV/AIDS Reporting System will be matched with Florida Vital Records and National Death Index records to determine survival status. Surveillance records will be merged with zip-code level socioeconomic data and city level segregation indices from the 2000 U.S. Census and county level health care resource and rural/urban classification data from the Health Resources and Services Administration Area Resource Files. Survival analysis using Cox Proportional Hazards and multilevel models will be conducted. A better understanding of the contribution of contextual factors associated with decreased survival among African Americans can lay the necessary groundwork to guide intervention studies and policy changes to improve survival among African Americans. This supports the National Center for Minority Health and Health Disparities mission to "reduce and ultimately eliminate health disparities."