County-level socioeconomic status and survival after HIV diagnosis, United States.
OBJECTIVE
To estimate relative survival (RS) after human immunodeficiency virus (HIV) diagnosis, by race/ethnicity and county-level socioeconomic status (SES).


METHODS
We estimated 5-year RS by age, race/ethnicity, transmission category, sex, diagnosis year, CD4 count, and by county-level SES variables from the U.S. Census. Data, from the national HIV/AIDS Reporting System, were for HIV-infected persons ages > or =13 years (diagnosis during 1996-2003 and follow-up through 2005). We calculated RS proportions by using a maximum likelihood algorithm and modeled the relative risk of excess death (RR) using generalized linear models, with poverty as a random effect.


RESULTS
For men, RS was worse in counties with larger proportions of people living below the 2000 U.S. poverty level (87.7% for poverty of > or =20% vs. 90.1% for poverty of <5.0%) and where unemployment was greater (87.8% where unemployment > 7.1% vs. 90.5% where unemployment < 4.0%). The effects of county-level SES on RS of women were similar. In multilevel multivariate models, RR for men and women within 5 years after an HIV diagnosis was significantly worse in counties where 10.0-19.9% (compared with <5.0%) lived below the poverty level (RR = 1.3 [95% CI 1.2-1.5] and RR = 1.8 [95% CI 1.4-2.2], respectively).


CONCLUSIONS
RS was worse in lower SES areas. To help address the impact of county-level SES, resources for HIV testing, care, and proven economic interventions should be directed to areas with concentrations of economically disadvantaged people.
McDavid Harrison
Kathleen
K
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. KMcDavid@cdc.gov
Ling
Qiang
Q
Song
Ruiguang
R
Hall
H Irene
HI
D000293:Adolescent; D000328:Adult; D000368:Aged; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000208:ethnology* / Q000401:mortality*; D020276:HIV Long-Term Survivors; D006801:Humans; D016013:Likelihood Functions; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011156:Population Density; D044469:Racial Groups; D012923:Social Class; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D047568:Unsafe Sex; D055815:Young Adult