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. 2021 Nov 1;32(6):877-885.
doi: 10.1097/EDE.0000000000001409.

Poverty, Deprivation, and Mortality Risk Among Women With HIV in the United States

Andrew Edmonds  1 , Alexander Breskin  1   2 , Stephen R Cole  1 , Daniel Westreich  1 , Catalina Ramirez  3 , Jennifer Cocohoba  4 , Gina Wingood  5 , Mardge H Cohen  6 , Elizabeth T Golub  7 , Seble G Kassaye  8 , Lisa R Metsch  5 , Anjali Sharma  9 , Deborah Konkle-Parker  10 , Tracey E Wilson  11 , Adaora A Adimora  1   3
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Poverty, Deprivation, and Mortality Risk Among Women With HIV in the United States

Andrew Edmonds et al. Epidemiology. .

Abstract

Background: Prior studies suggest neighborhood poverty and deprivation are associated with adverse health outcomes including death, but evidence is limited among persons with HIV, particularly women. We estimated changes in mortality risk from improvement in three measures of area-level socioeconomic context among participants of the Women's Interagency HIV Study.

Methods: Starting in October 2013, we linked geocoded residential census block groups to the 2015 Area Deprivation Index (ADI) and two 2012-2016 American Community Survey poverty variables, categorized into national tertiles. We used parametric g-computation to estimate, through March 2018, impacts on mortality of improving each income or poverty measure by one and two tertiles maximum versus no improvement.

Results: Of 1596 women with HIV (median age 49), 91 (5.7%) were lost to follow-up and 83 (5.2%) died. Most women (62%) lived in a block group in the tertile with the highest proportions of individuals with income:poverty <1; 13% lived in areas in the tertile with the lowest proportions. Mortality risk differences comparing a one-tertile improvement (for those in the two highest poverty tertiles) in income:poverty <1 versus no improvement increased over time; the risk difference was -2.2% (95% confidence interval [CI] = -3.7, -0.64) at 4 years. Estimates from family income below poverty level (-1.0%; 95% CI = -2.7, 0.62) and ADI (-1.5%; 95% CI = -2.8, -0.21) exposures were similar.

Conclusions: Consistent results from three distinct measures of area-level socioeconomic environment support the hypothesis that interventions to ameliorate neighborhood poverty or deprivation reduce mortality risk for US women with HIV. See video abstract at, http://links.lww.com/EDE/B863.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure.
Figure.
Cumulative mortality risks (lefthand panels) and risk differences (righthand panels), three measures of area-level poverty or deprivation.
Figure.
Figure.
Cumulative mortality risks (lefthand panels) and risk differences (righthand panels), three measures of area-level poverty or deprivation.
See this image and copyright information in PMC

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