title: Examination of inequalities in HIV/AIDS mortality in the United States from a fundamental cause perspective.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, NY, USA.
authors.forename: Marcie S
authors.initials: MS
authors.lastname: Rubin
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Colen
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Link
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000401:mortality / Q000706:statistics & numerical data; D016010:Binomial Distribution; D044383:Black People / Q000706:statistics & numerical data; D016001:Confidence Intervals; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American
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