%0 Journal Article
%T Widening Socioeconomic, Racial, and Geographic Disparities in HIV/AIDS Mortality in the United States, 1987每2011
%A Gopal K. Singh
%A Romuladus E. Azuine
%A Mohammad Siahpush
%J Advances in Preventive Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/657961
%X This study examined the extent to which socioeconomic and racial and geographic disparities in HIV/AIDS mortality in the United States changed between 1987 and 2011. Census-based deprivation indices were linked to county-level mortality data from 1987 to 2009. Log-linear, least-squares, and Poisson regression were used to model mortality trends and differentials. HIV/AIDS mortality rose between 1987 and 1995 and then declined markedly for all groups between 1996 and 2011. Despite the steep mortality decline, socioeconomic gradients and racial and geographic disparities in HIV/AIDS mortality increased substantially during the study period. Compared to whites, blacks had 3 times higher HIV/AIDS mortality in 1987 and 8 times higher mortality in 2011. In 1987, those in the most-deprived group had 1.9 times higher HIV/AIDS mortality than those in the most-affluent group; the corresponding relative risks increased to 2.9 in 1998 and 3.6 in 2009. Socioeconomic gradients existed across all race-sex groups, with mortality risk being 8每16 times higher among blacks than whites within each deprivation group. Dramatic reductions in HIV/AIDS mortality represent a major public health success. However, slower mortality declines among more deprived groups and blacks contributed to the widening gap. Mortality disparities reflect inequalities in incidence, access to antiretroviral therapy, and patient survival. 1. Introduction Social inequalities in health, disease, and mortality have long represented an important area of public health research in the United States [1每4]. Previous research has shown the dynamic nature of health inequalities in the USA, with social inequalities in health and many disease outcomes either persisting or widening over time against a backdrop of consistent improvements in life expectancy and mortality among Americans [1, 3每7]. Reduction of health inequalities, including those between socioeconomic and racial/ethnic groups, has been an important policy goal for the United States since 1990, as specified in its national health initiative, Healthy People [3, 6, 8每10]. Trends and contemporary patterns in HIV/AIDS mortality are routinely analyzed by age, sex, race/ethnicity, and state of residence in the United States [1, 11每13]. A few US studies have also examined differentials in HIV/AIDS mortality according to socioeconomic status (SES) or area-based deprivation level [14每16]. However, studies of temporal socioeconomic and geographic disparities in HIV/AIDS mortality are quite rare in the USA [14每16]. According to the Centers for Disease Control
%U http://www.hindawi.com/journals/apm/2013/657961/