Retrospective cohort study of racial disparities in HIV survival, Florida

项目摘要 尽管高活性抗逆转录病毒疗法已广泛使用了10多年， 非裔美国人并没有从人类生存的改善中受益。 免疫缺陷病毒（HIV）感染的程度与非西班牙裔白人相同。 感染艾滋病毒的非洲裔美国人的存活率大大低于 在非西班牙裔白人中。我们的目标是估计上下文因素的作用， 社区剥夺，隔离，和农村居住在解释生存 非裔美国人的不利因素，并描述在何种程度上， 获得性免疫缺陷综合征诊断时间之间的变化 （艾滋病）和死亡。我们有五个具体目标：1）评估社区层面的效果 贫困和农村居住对艾滋病毒存活率的种族差异的影响; 2） 估计种族隔离对艾滋病毒存活率的影响; 3）描述 艾滋病诊断与死亡之间的社区社会经济状况; 4)比较艾滋病发生时和 诊断和死亡; 5）描述农村到城市的模式和预测因素 艾滋病诊断和死亡之间的迁移。我们将进行一次回顾 对1993-2006年诊断为艾滋病的佛罗里达居民进行的队列研究。监控 佛罗里达卫生部艾滋病毒/艾滋病报告系统的记录将 与佛罗里达生命记录和国家死亡指数记录相匹配， 生存状态监控记录将与邮政编码级别的社会经济 2000年美国人口普查数据和城市一级的隔离指数以及县级 卫生资源和来自卫生资源的城乡分类数据， 服务管理区域资源文件。采用考克斯比例分析法进行生存分析 将进行危害和多水平模型。更好地理解 与非洲人生存率下降相关的背景因素的贡献 美国人可以为指导干预研究和政策奠定必要的基础 改善非裔美国人的生存状况。这支持了国家 少数民族健康和健康差异中心的使命是“减少和最终 消除健康差距。"

PROJECT SUMMARY Despite highly active antiretroviral therapy being widely available for over 10 years, 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."