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. 2010 Jun;100(6):1053-9.
doi: 10.2105/AJPH.2009.170241. Epub 2010 Apr 19.

Examination of inequalities in HIV/AIDS mortality in the United States from a fundamental cause perspective

Marcie S Rubin  1 , Cynthia G Colen, Bruce G Link
Affiliations

Examination of inequalities in HIV/AIDS mortality in the United States from a fundamental cause perspective

Marcie S Rubin et al. Am J Public Health. 2010 Jun.

Erratum in

  • Am J Public Health. 2011 Jan;101(1):5

Abstract

Objectives: We examined changes in socioeconomic status (SES) and Black to White inequalities in HIV/AIDS mortality in the United States before and after the introduction of highly active antiretroviral therapy (HAART).

Methods: Taking a fundamental cause perspective, we used negative binomial regression to analyze trends in county-level gender-, race-, and age-specific HIV/AIDS mortality rates among those aged 15 to 64 years during the period 1987-2005.

Results: Although HIV/AIDS mortality rates decreased once HAART became available, the declines were not uniformly distributed among population groups. The associations between SES and HIV/AIDS mortality and between race and HIV/AIDS mortality, although present in the pre-HAART period, were significantly greater in the peri- and post-HAART periods, with higher SES and White race associated with the greatest declines in mortality during the post-HAART period.

Conclusions: Our findings support the fundamental cause hypothesis, as the introduction of a life-extending treatment exacerbated inequalities in HIV/AIDS mortality by SES and by race. In addition to a strong focus on factors that improve overall population health, more effective public health interventions and policies would facilitate an equitable distribution of health-enhancing innovations.

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Figures

FIGURE 1
FIGURE 1
HIV/AIDS deaths per 100 000 population among (a) Whites aged 15 to 64 years and (b) Blacks aged 15 to 64 years, by age group and year: United States, 1987–2005.
FIGURE 2
FIGURE 2
Incidentrate ratios from negative binomial regression analysis comparing HIV/AIDS mortality among low-SES and high-SES counties during the pre-, peri-, and post-HAART periods: United States, 1987–2005. Note. HAART = highly active antiretroviral therapy; IRR = incident rate ratio; SES = socioeconomic status. For each period, the results from the model were adjusted for age, gender, and urbanicity. Low-SES counties were at the 95th percentile and high-SES counties were at the 5th percentile (reference group).
FIGURE 3
FIGURE 3
Incidentrate ratios from negative binomial regression analysis comparing HIV/AIDS mortality among Blacks and Whites during the pre-, peri-, and post-HAART periods: United States, 1987–2005. Note. HAART = highly active antiretroviral therapy; IRR = incident rate ratio. For each period, the results from the model were adjusted for age, gender, and urbanicity. Whites were the reference group.
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Comment in

  • Relative measures alone tell only part of the story.
    King NB, Kaufman JS, Harper S. King NB, et al. Am J Public Health. 2010 Nov;100(11):2014-5; author reply 2015-6. doi: 10.2105/AJPH.2010.203232. Epub 2010 Sep 23. Am J Public Health. 2010. PMID: 20864691 Free PMC article. No abstract available.

References

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    1. Link BG, Phelan JC. Social conditions as fundamental causes of disease. J Health Soc Behav 1995;Spec No:80–94 - PubMed

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