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）感染的生存率提高中获益。感染艾滋病毒的非洲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、隔离和农村居住等背景因素在解释非洲裔美国人生存劣势方面的作用，并描述这些因素在诊断为获得性免疫缺陷综合征（艾滋病）和死亡之间的变化程度。我们有五个具体目标：1)估计社区层面的贫困和农村居住对艾滋病毒生存的种族差异的影响；2)估计种族隔离对HIV存活的影响；3)艾滋病诊断至死亡期间社区社会经济地位的变化特征；4)比较艾滋病诊断时间与死亡时间之间的社区种族隔离程度；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居民进行回顾性队列研究。来自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，以确定生存状况。监测记录将与邮政编码级别的社会经济数据和来自2000年美国人口普查的城市级别隔离指数、县级卫生保健资源以及来自卫生资源和服务管理局区域资源文件的农村/城市分类数据合并。采用Cox比例风险和多水平模型进行生存分析。更好地了解与非洲裔美国人存活率下降相关的环境因素的贡献，可以为指导干预研究和政策变化奠定必要的基础，以提高非洲裔美国人的存活率。这支持了国家少数民族健康和健康差异中心“减少并最终消除健康差异”的使命。

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."