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Trends in Racial/Ethnic Disparities Among Patients Living with HIV in Texas, 1996 to 2013. J Racial Ethn Health Disparities 2017; 5:1023-1032. [PMID: 29270841 DOI: 10.1007/s40615-017-0450-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/02/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Abstract
National studies show that Blacks with HIV have higher mortality rates compared to Whites. This study aimed to identify trends in Black racial disparities among Texas residents living with HIV. Using HIV surveillance data from the Texas Department of State Health Services, a cohort of HIV-diagnosed patients (N = 70,996) were identified and grouped according to year of diagnosis, 1996-1997 (T1), 1998-2006 (T2), 2007-2010 (T3), and 2011-2013 (T4). Survival analysis was used to examine racial differences in death rate (analysis 1) and clinical progression to AIDS (analysis 2) for each subcohort, using Blacks as the reference group. In analysis 1, Whites (hazard ratio, HR = 0.80, 95% confidence interval, CI = 0.74-0.87, p < 0.001; HR = 0.82, 95% CI = 0.78-0.87, p < 0.001; respectively) and Hispanics (HR = 0.72, 95% CI = 0.66-0.79, p < 0.001; HR = 0.77, 95% CI = 0.74-0.81, p < 0.001, respectively) had lower death rates in T1 and T2. This remained significant after adjusting for covariates. In T3, death rate was higher for Hispanics after adjustment (HR = 1.13, 95% CI = 1.00-1.28, p < 0.05). In T4, death rate was higher for Whites (HR = 1.66, 95% CI = 1.30-2.13, p < 0.001) and Hispanics (HR = 1.66, 95% CI = 1.34-2.06, p < 0.001). These relationships became non-significant after adjusting for covariates. In analysis 2, the rate of clinical progression to AIDS was higher for Hispanics in all subcohorts. The significance remained after adjusting for covariates. The rate of clinical progression to AIDS was lower for Whites after adjustments in T2 and T3. Additional studies are needed to understand factors that may explain this unexpected finding of improved survival for Blacks over time. Such studies may inform decision-making in HIV care to reduce Black HIV disparities.
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Disparities in Female Breast Cancer Stage at Diagnosis in New Jersey: A Spatial-Temporal Analysis. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 23:477-486. [PMID: 28430705 PMCID: PMC5548504 DOI: 10.1097/phh.0000000000000524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Despite improvements in early detection of breast cancer, disparities persist in stage at diagnosis, which is an important prognostic factor.
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Rodrigues NCP, Almeida ASD, Braga JU, O'Dwyer G, Apratto Junior PC, Daumas RP, Lino VTS, Andrade MKDN, Monteiro DLM, Barros MBDL. Spatial dynamics of AIDS incidence in the elderly in Rio de Janeiro, Brazil, 1997-2011. CAD SAUDE PUBLICA 2016; 31:1721-31. [PMID: 26375650 DOI: 10.1590/0102-311x00152914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The dynamics of the spread of the AIDS epidemic ranges according to the characteristics of each geographical region in different population groups. The aim of this study was to evaluate spatial and temporal trends of the AIDS epidemic among the elderly in the State of Rio de Janeiro, Brazil. A retrospective study using spatial analysis techniques was conducted among AIDS cases (≥ 60 years) diagnosed from 1997-2011. The Poisson regression model was used to assess the relationship between year of diagnosis and incidence of AIDS, adjusted by sex. The AIDS epidemic began in the south coast of the state and gradually reached neighboring cities. The highest rates were found in regions around Rio de Janeiro and Niterói cities. The highest smoothed rates of the period were observed in Niterói in 2002-2006: 11.87/100,000 (men) and 8,5/100,000 (women). AIDS incidence rates among the elderly have stabilized in recent decades. To prevent HIV from spreading further among the general population, greater attention should be given to the older population.
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Affiliation(s)
| | | | - José Ueleres Braga
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, BR
| | - Gisele O'Dwyer
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, BR
| | | | - Regina Paiva Daumas
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, BR
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Pellowski JA, Kalichman SC, Matthews KA, Adler N. A pandemic of the poor: social disadvantage and the U.S. HIV epidemic. AMERICAN PSYCHOLOGIST 2013; 68:197-209. [PMID: 23688088 PMCID: PMC3700367 DOI: 10.1037/a0032694] [Citation(s) in RCA: 299] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The U.S. HIV/AIDS epidemic has evolved over the past 30 years and is now concentrated in socially marginalized and disenfranchised communities. The health disparities in this epidemic are striking, with most HIV infections occurring in sexual minorities and communities of color. While widely recognized, the health disparities in HIV and AIDS are not often discussed. In this article, we examine the factors underlying health disparities in the U.S. HIV epidemic. We first discuss the interlocking relationships between biological, social, and behavioral factors that drive HIV/AIDS epidemics. Guided by a well-established conceptual model of health disparities, we then describe the social positions of those most affected by HIV and AIDS, particularly racial and gender groups. Structural and economic conditions-including environmental resources, constraints, access to care, and psychosocial influences-are examined in relation to HIV disease trajectories. Greater attention to contextual factors and comorbidities is needed to reduce the health disparities in HIV/AIDS.
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Hsu CE, Watson K, Boekeloo B, Shang N, Metzger C, Downer G. The use of emerging informatics techniques to evaluate the delivery of NMAETC programs to address HIV and AIDS disparities. J Natl Med Assoc 2011; 102:1116-22. [PMID: 21287891 DOI: 10.1016/s0027-9684(15)33401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Information technologies are employed to evaluate health program and better target recruitment of health care workforce for underserved communities, where needs for providers are greatest. With increased resources in reducing human immunodeficiency virus (HIV)/AIDS disparities and provider training, it may be important to know whether training is delivered in geographic areas where HIV/AIDS demonstrates high prevalence. The present study employs an informatics approach to identifying effectiveness of AIDS educational intervention in minority populations adversely affected by the disease. We seek to assess the National Minority AIDS Education and Training Center (NMAETC) on whether training activities are delivered appropriately in areas with high AIDS prevalence. METHODS A geographic information systems application was developed to relate NMAETC provider training activities to its spatial relationship of AIDS prevalence of 4 major US racial/ethnic groups (fiscal years 2005-2006). Trainees' locations were geocoded by zip code. We overlaid AIDS prevalence of major demographic communities by state with the US Census region and division boundaries to visually inspect the patterns of distribution and potential spatial association. RESULTS NMAETC training better targeted providers in 3 US Census regions and census divisions. The regions with higher provider training level generally corresponded to geographic areas with high AIDS prevalence for some minority populations. Additional efforts could be extended to recruit providers in the areas where the incidences were high for some communities. CONCLUSIONS Most NMAETC provider training activities occurred in the states with a high AIDS prevalence. Additional efforts could be extended to recruit the providers in those regions where HIV/AIDS are more prevalent for some minority populations.
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Affiliation(s)
- Chiehwen Ed Hsu
- University of Texas School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin, Houston, Ste 600, TX 77030, USA.
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Hixson BA, Omer SB, del Rio C, Frew PM. Spatial clustering of HIV prevalence in Atlanta, Georgia and population characteristics associated with case concentrations. J Urban Health 2011; 88:129-41. [PMID: 21249526 PMCID: PMC3042078 DOI: 10.1007/s11524-010-9510-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We assessed prevalent HIV cases in Atlanta to examine case distribution trends and population characteristics at the census tract level that may be associated with clustering effects. We calculated cluster characteristics (area and internal HIV prevalence) via Kuldorff's spatial scan method. Subsequent logistic regression analyses were performed to analyze sociodemographics associated with inclusion in a cluster. Organizations offering voluntary HIV testing and counseling services were identified and we assessed average travel time to access these services. One large cluster centralized in downtown Atlanta was identified that contains 60% of prevalent HIV cases. The prevalence rate within the cluster was 1.34% compared to 0.32% outside the cluster. Clustered tracts were associated with higher levels of poverty (OR = 1.19), lower density of multi-racial residents (OR = 1.85), injection drug use (OR = 1.99), men having sex with men (OR = 3.01), and men having sex with men and IV drug use (OR = 1.6). Forty-two percent (N = 11) of identified HIV service providers in Atlanta are located in the cluster with an average travel time of 13 minutes via car to access these services (SD = 9.24). The HIV epidemic in Atlanta is concentrated in one large cluster characterized by poverty, men who have sex with men (MSM), and IV drug usage. Prevention efforts targeted to the population living in this area as well as efforts to address the specific needs of these populations may be most beneficial in curtailing the epidemic within the identified cluster.
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Affiliation(s)
- Brooke A Hixson
- The Hope Clinic of the Emory Vaccine Center, Decatur, GA, USA
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Oramasionwu CU, Hunter JM, Skinner J, Ryan L, Lawson KA, Brown CM, Makos BR, Frei CR. Black race as a predictor of poor health outcomes among a national cohort of HIV/AIDS patients admitted to US hospitals: a cohort study. BMC Infect Dis 2009; 9:127. [PMID: 19671170 PMCID: PMC2736968 DOI: 10.1186/1471-2334-9-127] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 08/11/2009] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In general, the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) population has begun to experience the benefits of highly active antiretroviral therapy (HAART); unfortunately, these benefits have not extended equally to Blacks in the United States, possibly due to differences in patient comorbidities and demographics. These differences include rates of hepatitis B and C infection, substance use, and socioeconomic status. To investigate the impact of these factors, we compared hospital mortality and length of stay (LOS) between Blacks and Whites with HIV/AIDS while adjusting for differences in these key characteristics. METHODS The 1996-2006 National Hospital Discharge Surveys were used to identify HIV/AIDS patients admitted to US hospitals. Survey weights were incorporated to provide national estimates. Patients < 18 years of age, those who left against medical advice, those with an unknown discharge disposition and those with a LOS < 1 day were excluded. Patients were stratified into subgroups by race (Black or White). Two multivariable logistic regression models were constructed with race as the independent variable and outcomes (mortality and LOS > 10 days) as the dependent variables. Factors that were significantly different between Blacks and Whites at baseline via bivariable statistical tests were included as covariates. RESULTS In the general US population, there are approximately 5 times fewer Blacks than Whites. In the present study, 1.5 million HIV/AIDS hospital discharges were identified and Blacks were 6 times more likely to be hospitalized than Whites. Notably, Blacks had higher rates of substance use (30% vs. 24%; P < 0.001), opportunistic infections (27% vs. 26%; P < 0.001) and cocaine use (13% vs. 5%; P < 0.001). Conversely, fewer Blacks were co-infected with hepatitis C virus (8% vs. 12%; P < 0.001). Hepatitis B virus was relatively infrequent (3% for both groups). Crude mortality rates were similar for both cohorts (5%); however, a greater proportion of Blacks had a LOS > 10 days (21% vs. 19%; P < 0.001). Black race, in the presence of comorbidities, was correlated with a higher odds of LOS > 10 days (OR, 95% CI = 1.20 [1.10-1.30]), but was not significantly correlated with a higher odds of mortality (OR, 95% CI = 1.07 [0.93-1.25]). CONCLUSION Black race is a predictor of LOS > 10 days, but not mortality, among HIV/AIDS patients admitted to US hospitals. It is possible that racial disparities in hospital outcomes may be closing with time.
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Affiliation(s)
- Christine U Oramasionwu
- College of Pharmacy, The University of Texas, Austin, TX, USA
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
| | - Jonathan M Hunter
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
| | - Jeff Skinner
- The National Institute of Allergy and Infectious Diseases, The National Institutes of Health, Bethesda, MD, USA
| | - Laurajo Ryan
- College of Pharmacy, The University of Texas, Austin, TX, USA
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
| | | | - Carolyn M Brown
- College of Pharmacy, The University of Texas, Austin, TX, USA
| | - Brittany R Makos
- College of Pharmacy, The University of Texas, Austin, TX, USA
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
| | - Christopher R Frei
- College of Pharmacy, The University of Texas, Austin, TX, USA
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
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