A proposal of measures for monitoring social disparities in health using AIDS and liver disease mortality before and after HAART.
BACKGROUND
To assess the more appropriate measures for monitoring health differences and evaluating the impact of interventions based on the real burden of the health problem in the population and on the best alternative for communication with policymakers and with society at large.


METHODS
Disparity in mortality from acquired immunodeficiency syndrome (AIDS) and liver disease were measured in two cohorts of Spanish men: before and after the introduction of highly active antiretroviral therapy (HAART). Men were grouped into managers/professionals/technicians, clerks/service workers/manual workers and unemployed. The mortality rate difference and the mortality rate ratio in clerks/service workers/manual workers and in unemployed vs. managers/professionals/technicians were estimated. Moreover, various summary measures of absolute disparity were also calculated.


RESULTS
Between the first and second period, the AIDS mortality rate difference decreased from 21.9 to 5.9 per 100,000 person-years in clerks/service workers/manual workers and from 117.2 to 59.3 in unemployed, whereas the liver mortality rate difference increased from 4.7 to 6.4 and from 37.4 to 48.9, respectively. The AIDS mortality rate ratio increased by 11% in clerks/service workers/manual workers and by 50% in unemployed, while the liver disease mortality rate ratio increased by almost 400% in both groups. The summary measures of disparity decreased in AIDS mortality and increased in liver disease, although the magnitude of the change varied from one measure to another.


CONCLUSIONS
The findings in unemployed men were the most important from the public health perspective; however, they could not be adequately identified with either mortality rate ratios or summary measures of absolute disparity.
Regidor
Enrique
E
Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain. enriqueregidor@hotmail.com
Sánchez
Elisabeth
E
de la Fuente
Luis
L
Santos
Juana M
JM
Martínez
David
D
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D004651:Employment / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000706:statistics & numerical data*; D013030:Spain / Q000453:epidemiology