Examination of inequalities in HIV/AIDS mortality in the United States from a fundamental cause perspective.
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.
Rubin
Marcie S
MS
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, NY, USA.
Colen
Cynthia G
CG
Link
Bruce G
BG
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
Am J Epidemiol. 2006 Nov 1;164(9):835-40; discussion 841-3
16968860
J Health Soc Behav. 2004 Sep;45(3):265-85
15595507
Natl Vital Stat Rep. 2008 Apr 24;56(10):1-120
18512336
MMWR Suppl. 1987 Aug 14;36(1):1S-15S
3039334
Am J Public Health. 1995 Jul;85(7):949-56
7604919
J Acquir Immune Defic Syndr. 2001 Aug 15;27(5):467-71
11511824
JAMA. 1998 Jun 3;279(21):1703-8
9624022
Am J Epidemiol. 1998 Sep 1;148(5):475-86
9737560
J Health Soc Behav. 1995;Spec No:80-94
7560851
Am J Public Health. 2006 Dec;96(12):2102-5
17123938
MMWR Recomm Rep. 1992 Dec 18;41(RR-17):1-19
1361652
N Engl J Med. 1998 Mar 26;338(13):853-60
9516219
BMJ. 1998 May 30;316(7145):1636-42
9603745
Annu Rev Public Health. 2006;27:167-94
16533114
Milbank Mem Fund Q. 1967 Apr;45(2):31-73
6034566
Public Health Rep. 1990 Jul-Aug;105(4):400-4
2116643