Retrospective cohort study of racial disparities in HIV survival, Florida

描述(由申请人提供)：非洲裔美国人没有像非西班牙裔白人那样从人类免疫缺陷病毒(HIV)感染的存活率提高中受益。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。我们的目标是评估社区剥夺、种族隔离和农村居住等背景因素在解释非裔美国人生存劣势方面的作用，并表征这些因素在被诊断为获得性免疫缺陷综合征(AIDS)到死亡之间的变化程度。我们有五个具体目标：1)估计随着时间的推移，社区一级的剥夺和农村居住对艾滋病毒生存中的种族差异的影响；2)估计种族隔离对艾滋病毒生存的影响；3)表征艾滋病诊断和死亡期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时社区种族隔离的程度；5)描述艾滋病诊断和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年间被诊断为艾滋病的佛罗里达州居民进行一项回溯性队列研究。佛罗里达州卫生部艾滋病毒/艾滋病报告系统的监测记录将与佛罗里达州生命记录和国家死亡指数记录相匹配，以确定生存状态。监测记录将与2000年美国人口普查和县级卫生保健资源的邮政编码级别的社会经济数据和城市级隔离指数以及卫生资源和服务管理局区域资源文件的城乡分类数据合并。将使用COX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存活率下降相关的背景因素的作用，可以为指导干预研究和政策变化以提高非裔美国人存活率奠定必要的基础。这支持了国家少数民族健康和健康差距中心的使命，即“减少并最终消除健康差距”。

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."