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?
BACKGROUND
The aim of this study is to determine whether socioeconomic AIDS mortality inequalities before and after the introduction of highly active antiretroviral therapy (HAART) have increased or decreased in a Spanish city where HAART is free.


METHODS
The study used a trend design, including all Barcelona residents older than 19 years of age. All AIDS deaths, which occurred among these residents between 1991 and 2001 were included. The variables studied were age, sex, socioeconomic (SES) group and HIV transmission group. AIDS age-standardized mortality rates for each year were estimated. Poisson regression models were fitted to obtain the relative risk (RR) of AIDS death for each socioeconomic group with respect to the reference group.


RESULTS
AIDS mortality increased up until 1995 and subsequently decreased due to the introduction of HAART. The increase in AIDS mortality was greater in the lowest SES group, which had higher rates and a RR of dying larger than that of the highest SES group, fact that remained fairly stable over the whole period. A similar pattern was observed in intravenous drug users. In the homosexual transmission group, rates for the lowest SES group were higher for the whole period and increased until 1996, while rates for the other SES groups were lower and decreased over the entire period.


CONCLUSIONS
The fact that inequalities in AIDS mortality by SES group remained fairly stable for the whole period suggests that perhaps access to HAART, or adherence, is lower than desirable, in people of lower SES groups. These results ought to be taken into account when implementing treatment and prevention strategies.
Borrell
Carme
C
Agència de Salut Pública de Barcelona, Red de Centros de Epidemiología y Salud Pública, Barcelona, Spain. cborrell@aspb.es
Rodríguez-Sanz
Maica
M
Pasarín
M Isabel
MI
Brugal
M Teresa
MT
García-de-Olalla
Patricia
P
Marí-Dell'Olmo
Marc
M
Caylà
Joan
J
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000401:mortality* / Q000635:transmission; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics / Q000706:statistics & numerical data*; D002423:Cause of Death; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000458:organization & administration*; D010349:Patient Compliance; D011159:Population Surveillance; D011204:Poverty Areas; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome; D017664:Uncompensated Care / Q000191:economics; D014504:Urban Health; D035862:Vulnerable Populations / Q000706:statistics & numerical data