title: Individual and neighborhood predictors of mortality among HIV-positive Latinos with history of injection drug use, Florida, 2000-2011.
abstract: BACKGROUND
  The objectives are to examine disparities in all-cause mortality risk among HIV-positive Latinos with injection drug use (IDU) history, and to identify individual- and neighborhood-level predictors.
  
  
  METHODS
  Florida surveillance data for persons diagnosed with HIV 2000-2008 were merged with 2007-2011 administrative data from the American Community Survey. Hazard ratios (HR) were calculated using multi-level weighted Cox regression adjusting for individual and neighborhood (ZCTA-level) factors.
  
  
  RESULTS
  Of 10,989 HIV-positive Latinos, 10.3% had IDU history. Latinos with IDU history were at increased mortality risk compared with Latinos without IDU history after controlling for individual and neighborhood factors (adjusted HR [aHR] 1.61, 95% confidence interval [CI] 1.43-1.80). Factors associated with mortality for those with IDU history included: being 40-59 (aHR 6.48, 95% CI 1.41-121.05) and ≥60 years (aHR 18.75, 95% CI 3.83-356.45) compared with 13-19 years of age; being diagnosed with AIDS within 3 months of HIV (aHR 2.31, 95% CI 1.87-2.86); residing in an area with ≥50% Latinos compared with <25% Latinos (aHR 1.56, 95% CI 1.19-2.04); and residing in a rural compared with an urban area at the time of diagnosis (aHR 1.73, 95% CI 1.06-2.70). Race and neighborhood poverty were not predictors among those with IDU, but were among those without.
  
  
  CONCLUSIONS
  HIV-positive Latinos with IDU history are at increased mortality risk and have unique contributing factors. Tertiary prevention strategies should target those who are older, diagnosed at later stages, and those who live in predominantly Latino and rural areas.
authors.affiliation: Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, 11200 SW 8th St, Miami, FL 33199, United States; Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, United States.
authors.forename: Diana M
authors.initials: DM
authors.lastname: Sheehan
authors.affiliation: Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, 11200 SW 8th St, Miami, FL 33199, United States; Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, United States. Electronic address: trepkam@fiu.edu.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Trepka
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, United States.
authors.forename: Kristopher P
authors.initials: KP
authors.lastname: Fennie
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL 33136, United States.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Prado
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, United States.
authors.forename: Purnima
authors.initials: P
authors.lastname: Madhivanan
authors.affiliation: Department of Educational and Counseling Psychology, School of Education, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222, United States.
authors.forename: Frank R
authors.initials: FR
authors.lastname: Dillon
authors.affiliation: HIV/AIDS Section, Florida Department of Health, 4052 Bald Cypress Way, Tallahassee, FL 32399, United States.
authors.forename: Lorene M
authors.initials: LM
authors.lastname: Maddox
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005431:Florida / Q000453:epidemiology; D006679:HIV Seropositivity / Q000150:complications* / Q000401:mortality*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000401:mortality*; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Human immunodeficiency virus; Injection drug use; Latinos; Mortality; Neighborhood