Individual and community-level effects in the socioeconomic inequalities of AIDS-related mortality in an urban area of southern Europe.
OBJECTIVE
To study socioeconomic inequalities in AIDS mortality in Barcelona, Spain, during the periods 1991-6 (before highly active antiretroviral therapy (HAART)) and 1997-2001 (post-HAART) taking into account individual as well as community effects of socioeconomic level.


METHODS
Cross-sectional design.


METHODS
Barcelona, Spain.


METHODS
All residents aged > or =20 years. All AIDS-related deaths occurring between 1991 and 2001 were studied. The individual variables analysed were age, sex, educational level, neighbourhood of residence and HIV transmission group. Male unemployment was used as the community-level indicator of neighbourhood deprivation. Multilevel Poisson regression models were fitted to estimate the relationship between AIDS mortality and the individual- and community-level variables.


RESULTS
At the individual level, AIDS mortality relative risks (RR) were higher among intravenous drug users (IDUs) with lower educational level in both periods. For the younger population, the RR of AIDS-related mortality associated with having little education compared with having a primary education or more was 4.7 (95% CI 3.6 to 6.1) in men and 5.2 (95%CI 3.6 to 7.7) in women in the pre-HAART period, and 4.7 (95% CI 2.7 to 8.1) in men and 4.5 (95% CI 1.4 to 14.1) in women in the post-HAART period. At the community level, an area effect in AIDS mortality was found, which was more important in neighbourhoods having high deprivation in both periods, although the effect was most important in the post-HAART period.


CONCLUSIONS
This study has shown inequalities in AIDS mortality in terms of both individual variables and a community-level variable in the pre-HAART as well as in the post-HAART period. These socioeconomic inequalities of AIDS mortality must be considered when prevention and treatment strategies are implemented.
Marí-Dell'Olmo
Marc
M
Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain.
Rodríguez-Sanz
Maica
M
Garcia-Olalla
Patrícia
P
Pasarín
M Isabel
MI
Brugal
M Teresa
MT
Caylà
Joan A
JA
Borrell
Carme
C
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality* / Q000635:transmission; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D012307:Risk Factors; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000150:complications; D014504:Urban Health / Q000706:statistics & numerical data*