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 8–16 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 [1–4]. 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, 3–7]. 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, 8–10]. 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, 11–13]. A few US studies have also examined differentials in HIV/AIDS mortality according to socioeconomic status (SES) or area-based deprivation level [14–16]. However, studies of temporal socioeconomic and geographic disparities in HIV/AIDS mortality are quite rare in the USA [14–16]. According to the Centers for Disease Control
References
[1]
National Center for Health Statistics, 2011 with Special Feature on Socioeconomic Status and Health, US Department of Health and Human Services, Hyattsville, Md, USA, 2012.
[2]
E. M. Kitagawa and P. M. Hauser, Differential Mortality in the United States: A Study in Socioeconomic Epidemiology, Harvard University Press, Cambridge, Mass, USA, 1973.
[3]
G. K. Singh and M. Siahpush, “Widening socioeconomic inequalities in US life expectancy, 1980-2000,” International Journal of Epidemiology, vol. 35, no. 4, pp. 969–979, 2006.
[4]
G. K. Singh, “Area deprivation and widening inequalities in US mortality, 1969–1998,” American Journal of Public Health, vol. 93, no. 7, pp. 1137–1143, 2003.
[5]
G. K. Singh and M. Siahpush, “Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25–64 years by area socioeconomic status, 1969–1998,” International Journal of Epidemiology, vol. 31, no. 3, pp. 600–613, 2002.
[6]
G. K. Singh and M. D. Kogan, “Widening socioeconomic disparities in US childhood mortality, 1969-2000,” American Journal of Public Health, vol. 97, no. 9, pp. 1658–1665, 2007.
[7]
G. K. Singh, M. Siahpush, and S. D. Williams, “Changing urbanization patterns in US lung cancer mortality, 1950–2007,” Journal of Community Health, vol. 37, no. 2, pp. 412–420, 2012.
[8]
US Department of Health and Human Services, “Healthy People 2020,” January 2013, http://www.healthypeople.gov/2020/default.aspx.
[9]
US Department of Health and Human Services, Tracking Healthy People 2010, US Government Printing Office, Washington, DC, USA, 2000.
[10]
US Department of Health and Human Services, Healthy People 2010: Midcourse Review, US Government Printing Office, Washington, DC, USA, 2006.
[11]
K. D. Kochanek, J. Q. Xu, S. L. Murphy, A. M. Minino, and H. C. Kung, “Deaths: final data for 2009,” National Vital Statistics Reports, vol. 60, no. 3, pp. 1–167, 2011.
[12]
A. M. Minino and S. L. Murphy, “Death in the United States, 2010,” NCHS Data Brief, vol. 99, no. 10, pp. 1–8, 2012.
[13]
D. L. Hoyert, H. C. Kung, and B. L. Smith, “Deaths: preliminary data for 2003,” National Vital Statistics Reports, vol. 53, no. 15, pp. 1–48, 2005.
[14]
M. S. Rubin, C. G. Colen, and B. G. Link, “Examination of inequalities in HIV/AIDS mortality in the United States from a fundamental cause perspective,” American Journal of Public Health, vol. 100, no. 6, pp. 1053–1059, 2010.
[15]
A. M. Karpati, M. T. Bassett, and C. McCord, “Neighbourhood mortality inequalities in New York City, 1989-1991 and 1999-2001,” Journal of Epidemiology and Community Health, vol. 60, no. 12, pp. 1060–1064, 2006.
[16]
E. P. Simard, M. Fransua, D. Naishadham, and A. Jemal, “The influence of sex, race/ethnicity, and educational attainment on human immunodeficiency virus death rates among adults, 1993–2007,” Archives of Internal Medicine, vol. 172, no. 20, pp. 1591–1598, 2012.
[17]
Centers for Disease Control and Prevention, “Estimated HIV incidence in the United States, 2007–2010,” HIV Surveillance Supplemental Report, vol. 17, no. 4, pp. 1–26, 2012.
[18]
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, HIV in the United StAtes: At a Glance, Centers for Disease Control and Prevention, Atlanta, Ga, USA, 2012.
[19]
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, HIV and AIDS in the United States By Geographic Distribution, Centers for Disease Control and Prevention, Atlanta, Ga, USA, 2012.
[20]
National Center for Health Statistics, National Vital Statistics System, Mortality Multiple Cause-of-Death Public Use Data File Documentation, US Department of Health and Human Services, Hyattsville, Md, USA, 2012, http://www.cdc.gov/nchs/nvss/mortality_public_use_data.htm.
[21]
G. K. Singh, R. E. Azuine, M. Siahpush, and M. D. Kogan, “All-cause and cause-specific mortality among US youth: socioeconomic and rural-urban disparities and international patterns,” Journal of Urban Health, 2012.
[22]
US Census Bureau, Census of Population and Housing, 1990: Summary Tape File 3A on CD-ROM, US Department of Commerce, Washington, DC, USA, 1992.
[23]
US Census Bureau, Summary File 3, Technical Documentation. 2000 Census of Population and Housing, US Department of Commerce, Washington, DC, USA, 2005.
[24]
US Census Bureau, The 2009 American Community Survey, US Census Bureau, Washington, DC, USA, 2010, http://www.census.gov/acs/www/.
[25]
SAS Institute, Inc., SAS/STAT User's Guide, Version 9.1: the REG Procedure, SAS Institute Inc., Cary, NC, USA, 2004.
[26]
Bureau of Health Professions, Area Resource File, 2011-12, Technical Documentation, Health Resources and Services Administration, Rockville, Md, USA, 2012.
[27]
G. K. Singh, S. D. Williams, M. Siahpush, and A. Mulhollen, “Socioeconomic, rural-urban, and racial inequalities in US cancer mortality: part 1—all cancers and lung cancer and part II—colorectal, prostate, breast, and cervical cancers,” Journal of Cancer Epidemiology, vol. 2011, Article ID 107497, 27 pages, 2011.
[28]
R. S. Levine, N. C. Briggs, B. S. Kilbourne et al., “Black-white mortality from HIV in the United States before and after introduction of highly active antiretroviral therapy in 1996,” American Journal of Public Health, vol. 97, no. 10, pp. 1884–1892, 2007.
[29]
C. Borrell, M. Rodríguez-Sanz, M. I. Pasarín et al., “AIDS mortality before and after the introduction of highly active antiretroviral therapy: does it vary with socioeconomic group in a country with a National Health System?” European Journal of Public Health, vol. 16, no. 6, pp. 601–608, 2006.
[30]
M. Marí-Dell'Olmo, M. Rodríguez-Sanz, P. Garcia-Olalla et al., “Individual and community-level effects in the socioeconomic inequalities of AIDS-related mortality in an urban area of southern Europe,” Journal of Epidemiology and Community Health, vol. 61, no. 3, pp. 232–240, 2007.
[31]
S. Zierler, N. Krieger, Y. Tang et al., “Economic deprivation and AIDS incidence in Massachusetts,” American Journal of Public Health, vol. 90, no. 7, pp. 1064–1073, 2000.
[32]
W. E. Cunningham, R. D. Hays, N. Duan et al., “The effect of socioeconomic status on the survival of people receiving care for HIV infection in the United States,” Journal of Health Care for the Poor and Underserved, vol. 16, no. 4, pp. 655–676, 2005.
[33]
D. J. Gaskin, G. Y. Dinwiddie, K. S. Chan, and R. McCleary, “Residential segregation and disparities in health care utilization,” Medical Care Research and Review, vol. 69, no. 2, pp. 158–175, 2012.
[34]
K. White and L. N. Borrell, “Racial/ethnic residential segregation: framing the context of health risk and health disparities,” Health & Place, vol. 17, no. 2, pp. 438–448, 2011.
[35]
E. Reed, M. C. Santana, L. Bowleg, et al., “Experiences of racial discrimination and relation to sexual risk for HIV among a sample of urban black and African American men,” Journal of Urban Health, vol. 90, no. 2, pp. 314–322, 2013.
[36]
M. Heron, “Deaths: leading causes for 2009,” National Vital Statistics Reports, vol. 61, no. 7, pp. 1–95, 2012.
[37]
World Health Organization, World Health Statistics Report 2011, WHO, Geneva, Switzerland, 2011.
