1
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Hailu BA. Trend and principal components of HIV/AIDS among adults in SSA. Sci Rep 2024; 14:11098. [PMID: 38750039 PMCID: PMC11096374 DOI: 10.1038/s41598-024-55872-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/28/2024] [Indexed: 05/18/2024] Open
Abstract
This study aimed to identify the most important principal components (PCs) that contribute to the prevalence and change of HIV/AIDS in 44 SSA and data from different national and international datasets. The study estimated HIV prevalence, trend, and principal component analysis (PCA). Using the elbow method, the number of important PCs and contributions was identified. The quality of representation was checked, and more contributing variables for most important PCs were identified. Finally, the status by prevalence, the progress by trend, the more influenced component by PCA, and the more influenced variable with quality of representation by PCs were reported. The study found that HIV prevalence varied significantly, with 30 of the countries showed good progress/decline. Four PCs accounted for 51% of the total variance. Literacy, cohabitation, media exposure, and HIV status awareness are highly contributing factors. Based on these findings, a gap-based response will help reduce the burden of HIV.
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Oluyomi AO, Mazul AL, Dong Y, White DL, Hartman CM, Richardson P, Chan W, Garcia JM, Kramer JR, Chiao E. Area deprivation index and segregation on the risk of HIV: a U.S. Veteran case-control study. LANCET REGIONAL HEALTH. AMERICAS 2023; 20:100468. [PMID: 36992707 PMCID: PMC10041556 DOI: 10.1016/j.lana.2023.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/13/2023] [Accepted: 02/20/2023] [Indexed: 03/31/2023]
Abstract
Background Preventing HIV infection remains a critically important tool in the continuing fight against HIV/AIDS. The primary aim is to evaluate the effect and interactions between a composite area-level social determinants of health measure and an area-level measure of residential segregation on the risk of HIV/AIDS in U.S. Veterans. Methods Using the individual-level patient data from the U.S. Department of Veterans Affairs, we constructed a case-control study of veterans living with HIV/AIDS (VLWH) and age-, sex assigned at birth- and index date-matched controls. We geocoded patient's residential address to ascertain their neighborhood and linked their information to two measures of neighborhood-level disadvantage: area deprivation index (ADI) and isolation index (ISOL). We used logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI) for comparing VLWH with matched controls. We performed analyses for the entire U.S. and separately for each U.S. Census division. Findings Overall, living in minority-segregated neighborhoods was associated with a higher risk of HIV (OR: 1.88 (95% CI: 1.79-1.97) while living in higher ADI neighborhoods was associated with a lower risk of HIV (OR: 0.88; 95% CI: 0.84-0.92). The association between living in a higher ADI neighborhood and HIV was inconsistent across divisions, while living in minority-segregated neighborhoods was consistently associated with increased risk across all divisions. In the interaction model, individuals from low ADI and high ISOL neighborhoods had a higher risk of HIV in three divisions: East South Central; West South Central, and Pacific. Interpretation Our results suggest that residential segregation may prevent people in disadvantaged neighborhoods from protecting themselves from HIV independent from access to health care. There is the need to advance knowledge about the neighborhood-level social-structural factors that influence HIV vulnerability toward developing interventions needed to achieve the goal of ending the HIV epidemic. Funding US National Cancer Institute.
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Affiliation(s)
- Abiodun O. Oluyomi
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
| | - Angela L. Mazul
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Yongquan Dong
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Donna L. White
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Center for Translational Research in Inflammatory Disease (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA
| | - Christine M. Hartman
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Peter Richardson
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, USA
| | - Jose M. Garcia
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System and Div. of Geriatrics, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer R. Kramer
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA
| | - Elizabeth Chiao
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, Department of General Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Corresponding author. Epidemiology Department, T 713-792-3020 F 713-563-1367, Unit 1340, 1155 Pressler, Duncan Building (CPB), 4th Floor, D 713-792-1860 C 713-303-1978, USA.
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Cunningham CO, Zhang C, Hollins M, Wang M, Singh-Tan S, Joudrey PJ. Availability of medical cannabis services by racial, social, and geographic characteristics of neighborhoods in New York: a cross-sectional study. BMC Public Health 2022; 22:671. [PMID: 35387635 PMCID: PMC8988426 DOI: 10.1186/s12889-022-13076-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Within the United States (US), because racial/ethnic disparities in cannabis arrests continue, and cannabis legalization is expanding, understanding disparities in availability of legal cannabis services is important. Few studies report mixed findings regarding disparities in availability of legal cannabis services; none examined New York. We examined disparities in availability of medical cannabis services in New York. We hypothesized that New York census tracts with few Black or Hispanic residents, high incomes, high education levels, and greater urbanicity would have more medical cannabis services. Methods In this cross-sectional study, we used data from the 2018 US Census Bureau 5-year American Community Survey and New York Medical Marijuana Program. Main exposures were census tract characteristics, including urban–rural classification, percentage of Black and Hispanic residents, percentage of residents with bachelor’s degrees or higher, and median household income. Main outcomes were presence of at least one medical cannabis certifying provider and dispensary in each census tract. To compare census tracts’ characteristics with (vs. without) certifying providers and dispensaries, we used chi-square tests and t-tests. To examine characteristics independently associated with (vs. without) certifying providers, we used multivariable logistic regression. Results Of 4858 New York census tracts, 1073 (22.1%) had medical cannabis certifying providers and 37 (0.8%) had dispensaries. Compared to urban census tracts, suburban census tracts were 62% less likely to have at least one certifying provider (aOR = 0.38; 95% CI = 0.25–0.57). For every 10% increase in the proportion of Black residents, a census tract was 5% less likely to have at least one certifying provider (aOR = 0.95; 95% CI = 0.92–0.99). For every 10% increase in the proportion of residents with bachelor’s degrees or higher, a census tract was 30% more likely to have at least one certifying provider (aOR = 1.30; 95% CI = 1.21–1.38). Census tracts with (vs. without) dispensaries were more likely to have a higher percentage of residents with bachelor’s degrees or higher (43.7% vs. 34.1%, p < 0.005). Conclusions In New York, medical cannabis services are least available in neighborhoods with Black residents and most available in urban neighborhoods with highly educated residents. Benefits of legal cannabis must be shared by communities disproportionately harmed by illegal cannabis.
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Affiliation(s)
- Chinazo O Cunningham
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA.
| | - Chenshu Zhang
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Maegan Hollins
- Northwestern University, 633 Clark St, Evanston, IL, 60208, USA
| | - Melinda Wang
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - Sumeet Singh-Tan
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Paul J Joudrey
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
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4
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Zakaria A, Piper M, Douda L, Jackson NM, Flynn JC, Misra DP, Gardiner J, Sankari A. Determinants of all-cause in-hospital mortality among patients who presented with COVID-19 to a community teaching hospital in Michigan. Heliyon 2021; 7:e08566. [PMID: 34957338 PMCID: PMC8685232 DOI: 10.1016/j.heliyon.2021.e08566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/22/2021] [Accepted: 12/03/2021] [Indexed: 12/30/2022] Open
Abstract
Background & objectives Race plays an important role in healthcare disparities, often resulting in worse health outcomes. It is unclear if other patient factors and race interactions may influence mortality in patients with COVID-19. We aimed to evaluate how multiple determinants of all-cause in-hospital mortality from COVID-19 were linked to race. Methods A retrospective observational study was conducted at two hospitals in metropolitan Detroit. We identified patients aged ≥18 years-old who had tested positive for COVID-19 and were admitted between March 9 through May 16, 2020. Multivariable logistic regression was performed assessing predictors of all-cause in-hospital mortality in COVID-19. Results We identified 1064 unique patients; 74% were African Americans (AA). The all-cause in-hospital mortality was 21.7%, with the majority of deaths seen in AA (65.4%, P = 0.002) and patients 80 years or older (52%, P < 0.0001). AA women had lower all-cause mortality than AA men, white women, and white men based on race-gender interactions. In multivariable logistic regression analysis, older age (>80-year-old), dementia, and chronic kidney disease were associated with worse all-cause in-hospital mortality. Adjusted for race and body mass index (BMI), the main odds ratios (OR) and 95% confidence intervals (CI) are: Age 80 and older vs < 60 in females: OR = 7.4, 95% CI: 2.9, 18.7; in males OR = 7.3, 95% CI: 3.3, 16.2; Chronic Kidney Disease (CKD): OR = 1.7, 95% CI: 1.2, 2.6; Dementia: OR = 2.2, 95% CI: 1.5, 3.3. Conclusion Gender significantly modified the association of race and COVID-19 mortality. African American females had the lowest all-cause in-hospital mortality risk compared to other gender-race groups.
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Affiliation(s)
- Ali Zakaria
- Department of Internal Medicine, Division of Gastroenterology-Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, Michigan, USA
| | - Marc Piper
- Department of Internal Medicine, Division of Gastroenterology-Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, Michigan, USA
| | - Lahib Douda
- Department of Medical Education, Ascension Providence Hospital, Southfield, Michigan, USA
| | - Nancy M Jackson
- Department of Medical Education, Ascension Providence Hospital, Southfield, Michigan, USA
| | - Jeffrey C Flynn
- Department of Medical Education, Ascension Providence Hospital, Southfield, Michigan, USA
| | - Dawn P Misra
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, Lansing, Michigan, USA
| | - Joseph Gardiner
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, Lansing, Michigan, USA
| | - Abdulghani Sankari
- Department of Medical Education, Ascension Providence Hospital, Southfield, Michigan, USA
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Gutin I, Hummer RA. Social Inequality and the Future of U.S. Life Expectancy. ANNUAL REVIEW OF SOCIOLOGY 2021; 47:501-520. [PMID: 34366549 PMCID: PMC8340572 DOI: 10.1146/annurev-soc-072320-100249] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Despite decades of progress, the future of life expectancy in the United States is uncertain due to widening socioeconomic disparities in mortality, continued disparities in mortality across racial/ethnic groups, and an increase in extrinsic causes of death. These trends prompt us to scrutinize life expectancy in a high-income but enormously unequal society like the United States, where social factors determine who is most able to maximize their biological lifespan. After reviewing evidence for biodemographic perspectives on life expectancy, the uneven diffusion of health-enhancing innovations throughout the population, and the changing nature of threats to population health, we argue that sociology is optimally positioned to lead discourse on the future of life expectancy. Given recent trends, sociologists should emphasize the importance of the social determinants of life expectancy, redirecting research focus away from extending extreme longevity and towards research on social inequality with the goal of improving population health for all.
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Affiliation(s)
- Iliya Gutin
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516
- Corresponding author:
| | - Robert A. Hummer
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516
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6
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Benjamins MR, Saiyed N, Bunting S, Lorenz P, Hunt B, Glick N, Silva A. HIV mortality across the 30 largest U.S. cities: assessing overall trends and racial inequities. AIDS Care 2021; 34:916-925. [PMID: 34125639 DOI: 10.1080/09540121.2021.1939849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite decreases in overall HIV mortality in the U.S., large racial inequities persist. Most previous analyses of HIV mortality and mortality inequities have utilized national- or state-level data. METHODS Using vital statistics mortality data and American Community Survey population estimates, we calculated HIV mortality rates and Black:White HIV mortality rate ratios (RR) for the 30 most populous U.S. cities at two time points, 2010-2014 (T1) and 2015-2019 (T2). RESULTS Almost all cities (28) had HIV mortality rates higher than the national rate at both time points. At T2, HIV mortality rates ranged from 0.8 per 100,000 (San Jose, CA) to 15.2 per 100,000 (Baltimore, MD). Across cities, Black people were approximately 2-8 times more likely to die from HIV compared to White people at both time points. Over the decade, these racial disparities decreased at the national level (T1: RR = 11.0, T2: RR = 9.8), and in one city (Charlotte, NC). DISCUSSION We identified large geographic and racial inequities in HIV mortality in U.S. urban areas. These city-specific data may motivate change in cities and can help guide city leaders and other health advocates as they implement, test, and support policies and programming to decrease HIV mortality.
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Affiliation(s)
- Maureen R Benjamins
- Sinai Urban Health Institute, Chicago, IL, USA.,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Samuel Bunting
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Peter Lorenz
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Bijou Hunt
- Sinai Urban Health Institute, Chicago, IL, USA
| | | | - Abigail Silva
- Loyola University Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
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7
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Aburto JM, Kristensen FF, Sharp P. Black-white disparities during an epidemic: Life expectancy and lifespan disparity in the US, 1980-2000. ECONOMICS AND HUMAN BIOLOGY 2021; 40:100937. [PMID: 33246298 DOI: 10.1016/j.ehb.2020.100937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/08/2020] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Abstract
Covid-19 has demonstrated again that epidemics can affect minorities more than the population in general. We consider one of the last major epidemics in the United States: HIV/AIDS from ca. 1980-2000. We calculate life expectancy and lifespan disparity (a measure of variance in age at death) for thirty US states, finding noticeable differences both between states and between the black and white communities. Lifespan disparity allows us to examine distributional effects, and, using decomposition methods, we find that for six states lifespan disparity for blacks increased between 1980 and 1990, while life expectancy increased less than for whites. We find that we can attribute most of this to the impact of HIV/AIDS.
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Affiliation(s)
| | | | - Paul Sharp
- University of Southern Denmark, CAGE, CEPR, UK.
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8
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Hull S, Stevens R, Cobb J. Masks Are the New Condoms: Health Communication, Intersectionality and Racial Equity in COVID-Times. HEALTH COMMUNICATION 2020; 35:1740-1742. [PMID: 33095065 PMCID: PMC9043907 DOI: 10.1080/10410236.2020.1838095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Shawnika Hull
- School of Communication and Information, Rutgers University
| | - Robin Stevens
- Annenberg School for Communication and Journalism, University of Southern California
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9
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Levine RS, Johnson HM, Maki DG, Hennekens CH. Racial Inequalities in Mortality from Coronavirus: The Tip of the Iceberg. Am J Med 2020; 133:1151-1153. [PMID: 32442516 PMCID: PMC7236709 DOI: 10.1016/j.amjmed.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Robert S Levine
- Professor of Family and Community Medicine, Baylor College of Medicine, Houston, TX; Affiliate Professor, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Heather M Johnson
- Preventive Cardiologist/Cardiologist, Christine E. Lynn Women's Health &Wellness Center, Boca Raton, Regional Hospital/Baptist Health South Florida; Adjunct Associate Professor, University of Wisconsin School of Medicine & Public Health, Madison
| | - Dennis G Maki
- Professor of Medicine, University of Wisconsin School of Medicine & Public Health, Madison
| | - Charles H Hennekens
- First Sir Richard Doll Professor & Senior Academic Advisor to the Dean, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton; Adjunct Professor, Baylor College of Medicine, Houston, TX.
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10
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Truman BI, Moonesinghe R, Brown YT, Chang MH, Mermin JH, Dean HD. Differential Association of HIV Funding With HIV Mortality by Race/Ethnicity, United States, 1999-2017. Public Health Rep 2020; 135:149S-157S. [PMID: 32735185 DOI: 10.1177/0033354920912716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Federal funds have been spent to reduce the disproportionate effects of HIV/AIDS on racial/ethnic minority groups in the United States. We investigated the association between federal domestic HIV funding and age-adjusted HIV death rates by race/ethnicity in the United States during 1999-2017. METHODS We analyzed HIV funding data from the Kaiser Family Foundation by federal fiscal year (FFY) and US age-adjusted death rates (AADRs) by race/ethnicity (Hispanic, non-Hispanic white, non-Hispanic black, and Asian/Pacific Islander and American Indian/Alaska Native [API+AI/AN]) from Centers for Disease Control and Prevention WONDER detailed mortality files. We fit joinpoint regression models to estimate the annual percentage change (APC), average APC, and changes in AADRs per billion US dollars in HIV funding, with 95% confidence intervals (CIs). For 19 data points, the number of joinpoints ranged from 0 to 4 on the basis of rules set by the program or by the user. A Monte Carlo permutation test indicated significant (P < .05) changes at joinpoints, and 2-sided t tests indicated significant APCs in AADRs. RESULTS Domestic HIV funding increased from $10.7 billion in FFY 1999 to $26.3 billion in FFY 2017, but AADRs decreased at different rates for each racial/ethnic group. The average rate of change in AADR per US billion dollars was -9.4% (95% CI, -10.9% to -7.8%) for Hispanic residents, -7.8% (95% CI, -9.0% to -6.6%) for non-Hispanic black residents, -6.7% (95% CI, -9.3% to -4.0%) for non-Hispanic white residents, and -5.2% (95% CI, -7.8% to -2.5%) for non-Hispanic API+AI/AN residents. CONCLUSIONS Increased domestic HIV funding was associated with faster decreases in age-adjusted HIV death rates for Hispanic and non-Hispanic black residents than for residents in other racial/ethnic groups. Increasing US HIV funding could be associated with decreasing future racial/ethnic disparities in the rate of HIV-related deaths.
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Affiliation(s)
- Benedict I Truman
- 1242 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ramal Moonesinghe
- 1242 Office of Minority Health and Health Equity, Office of the Deputy Director for Public Health Service and Implementation Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yolanda T Brown
- 1242 Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Man-Huei Chang
- 1242 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan H Mermin
- 1242 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hazel D Dean
- 1242 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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11
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Pan Y, Metsch LR, Gooden LK, Philbin MM, Daar ES, Douaihy A, Jacobs P, Del Rio C, Rodriguez AE, Feaster DJ. Viral suppression and HIV transmission behaviors among hospitalized patients living with HIV. Int J STD AIDS 2019; 30:891-901. [PMID: 31159715 DOI: 10.1177/0956462419846726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
From July 2012 to January 2014, the CTN0049 study, Project HOPE (Hospital Visit as Opportunity for Prevention and Engagement for HIV-infected Drug Users) interviewed 1227 people with HIV infection from 11 hospitals in the US to determine eligibility for participation in a randomized trial. Using these screening interviews, we conducted a cross-sectional study with multivariable analysis to examine groups that are at highest risk for having a detectable viral load (VL) and engaging in HIV transmission behaviors. Viral suppression was 42.8%. Persons with a detectable VL were more likely to have sex partners who were HIV-negative or of unknown status (OR = 1.72, 95% CI = 1.22–2.38), report not cleaning needles after injecting drugs (OR = 3.13, 95% CI = 1.33–7.14), and to engage in sex acts while high on drugs or alcohol (OR = 1.85, 95% CI = 1.28–2.7) compared to their counterparts. Many hospitalized people with HIV infection are unsuppressed and more likely to engage in HIV transmission behaviors than those with viral suppression. Developing behavioral interventions targeting HIV transmission behaviors toward patients with unsuppressed HIV VLs in the hospital setting has the potential to prevent HIV transmission.
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Affiliation(s)
- Yue Pan
- 1 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lisa R Metsch
- 2 Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lauren K Gooden
- 2 Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Morgan M Philbin
- 2 Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Eric S Daar
- 3 Los Angeles Biomedical Research Institute at Harbor, University of California Los Angeles Medical Center, Torrance, CA, USA
| | - Antoine Douaihy
- 4 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Petra Jacobs
- 5 Center for the Clinical Trials Network, National Institute on Drug Abuse, North Bethesda, MD, USA
| | - Carlos Del Rio
- 6 Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Allan E Rodriguez
- 7 Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel J Feaster
- 1 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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12
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Bhagwat P, Kapadia SN, Ribaudo HJ, Gulick RM, Currier JS. Racial Disparities in Virologic Failure and Tolerability During Firstline HIV Antiretroviral Therapy. Open Forum Infect Dis 2019; 6:ofz022. [PMID: 30793009 PMCID: PMC6372057 DOI: 10.1093/ofid/ofz022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Racial/ethnic disparities in HIV outcomes have persisted despite effective antiretroviral therapy. In a study of initial regimens, we found viral suppression varied by race/ethnicity. In this exploratory analysis, we use clinical and socioeconomic data to assess factors associated with virologic failure and adverse events within racial/ethnic groups. METHODS Data were from AIDS Clinical Trial Group A5257, a randomized trial of initial regimens with either atazanavir/ritonavir, darunavir/ritonavir, or raltegravir (each combined with tenofovir DF and emtricitabine). We grouped participants by race/ethnicity and then used Cox-proportional hazards regression to examine the impact of demographic, clinical, and socioeconomic factors on the time to virologic suppression and time to adverse event reporting within each racial/ethnic group. RESULTS We analyzed data from 1762 participants: 757 self-reported as non-Hispanic black (NHB), 615 as non-Hispanic white (NHW), and 390 as Hispanic. The proportion with virologic failure was higher for NHB (22%) and Hispanic (17%) participants compared with NHWs (9%). Factors associated with virologic failure were poor adherence and higher baseline HIV RNA level. Prior clinical AIDS diagnosis was associated with virologic failure for NHBs only, and unstable housing and illicit drug use for NHWs only. Factors associated with adverse events were female sex in all groups and concurrent use of medications for comorbidities in NHB and Hispanic participants only. CONCLUSIONS Clinical and socioeconomic factors that are associated with virologic failure and tolerability of antiretroviral therapy vary between and within racial and ethnic groups. Further research may shed light into mechanisms leading to disparities and targeted strategies to eliminate those disparities.
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Affiliation(s)
- Priya Bhagwat
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, California
| | - Shashi N Kapadia
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Roy M Gulick
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Judith S Currier
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Canedo JR, Miller ST, Myers HF, Sanderson M. Racial and ethnic differences in knowledge and attitudes about genetic testing in the US: Systematic review. J Genet Couns 2019; 28:587-601. [PMID: 30663831 DOI: 10.1002/jgc4.1078] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/25/2018] [Accepted: 12/03/2018] [Indexed: 12/26/2022]
Abstract
Precision medicine has grown over the past 20 years with the availability of genetic tests and has changed the one-size-fits-all paradigm in medicine. Precision medicine innovations, such as newly available genetic tests, could potentially widen racial and ethnic disparities if access to them is unequal and if interest to use them differs across groups. The objective of this systematic review was to synthesize existing evidence on racial and ethnic differences in knowledge of and attitudes toward genetic testing among adult patients and the general public in the US, focusing on research about the use of genetic testing in general, not disease-specific tests. Twelve articles published in 1997-2017 met inclusion and exclusion criteria, with 10 including knowledge variables and seven including attitude variables. Studies found consistent patterns of lower awareness of genetic testing in general among non-Whites compared to Whites, lower factual knowledge scores among Blacks and Hispanics/Latinos, and mixed findings of differences in awareness of direct-to-consumer (DTC) genetic testing or the term precision medicine. Blacks, Hispanics/Latinos, and non-Whites generally had more concerns about genetic testing than Whites. The findings suggest that patients and the general public need access to culturally appropriate educational material about the use of genetic testing in precision medicine.
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Affiliation(s)
- Juan R Canedo
- Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee
| | | | - Hector F Myers
- Center for Medicine, Health and Society, Vanderbilt University, Nashville, Tennessee
| | - Maureen Sanderson
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee
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Fletcher FE, Vidrine DJ, Trejo MB, Molina Y, Sha BE, Floyd BR, Sarhene N, Mator J, Matthews AK. "You Come Back to the Same Ole Shit:" A Qualitative Study of Smoking Cessation Barriers among Women Living with HIV: Implications for Intervention Development. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2019; 12:106-122. [PMID: 32963893 PMCID: PMC7505055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Although tobacco use among women living with HIV (WLWH) is decreasing, the prevalence is more than double that of women in the general population and remains an important health behavior to target among WLWH. Few smoking cessation interventions specifically focus on the unique social and medical needs of WLWH. Thus, the investigative team engaged WLWH (N=18) in qualitative focus groups to: 1) understand barriers and facilitators to smoking cessation; and 2) inform intervention structure and content priorities. Participants identified salient reasons for smoking and barriers to smoking cessation, which included coping with multiple life stressors, HIV-related stress, HIV-related stigma and social isolation. Further, WLWH highlighted the importance of long-term smoking cessation support, peer support, mental health content, religion/spirituality, and targeted risk messaging in smoking cessation intervention development. Study findings provide concrete, operational strategies for future use in a theory-based smoking cessation intervention, and underscore the importance of formative research to inform smoking cessation interventions for WLWH.
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Affiliation(s)
| | | | | | - Yamile' Molina
- University of Illinois at Chicago School of Public Health
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15
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Rice WS, Logie CH, Napoles TM, Walcott M, Batchelder AW, Kempf MC, Wingood GM, Konkle-Parker DJ, Turan B, Wilson TE, Johnson MO, Weiser SD, Turan JM. Perceptions of intersectional stigma among diverse women living with HIV in the United States. Soc Sci Med 2018; 208:9-17. [PMID: 29753137 PMCID: PMC6015551 DOI: 10.1016/j.socscimed.2018.05.001] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/28/2018] [Accepted: 05/02/2018] [Indexed: 10/17/2022]
Abstract
Attitudes and behavior that devalue individuals based upon their HIV status (HIV-related stigma) are barriers to HIV prevention, treatment, and wellbeing among women living with HIV. Other coexisting forms of stigma (e.g., racism, sexism) may worsen the effects of HIV-related stigma, and may contribute to persistent racial and gendered disparities in HIV prevention and treatment. Few studies examine perceptions of intersectional stigma among women living with HIV. From June to December 2015, we conducted 76 qualitative interviews with diverse women living with HIV from varied socioeconomic backgrounds enrolled in the Women's Interagency HIV Study (WIHS) in Birmingham, Alabama; Jackson, Mississippi; Atlanta, Georgia; and San Francisco, California. Interview guides facilitated discussions around stigma and discrimination involving multiple interrelated identities. Interviews were audio-recorded, transcribed verbatim, and coded using thematic analysis. Interviewees shared perceptions of various forms of stigma and discrimination, most commonly related to their gender, race, and income level, but also incarceration histories and weight. Women perceived these interrelated forms of social marginalization as coming from multiple sources: their communities, interpersonal interactions, and within systems and structures. Our findings highlight the complexity of social processes of marginalization, which profoundly shape life experiences, opportunities, and healthcare access and uptake among women living with HIV. This study highlights the need for public health strategies to consider community, interpersonal, and structural dimensions across intersecting, interdependent identities to promote the wellbeing among women living with HIV and to reduce social structural and health disparities.
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Affiliation(s)
- Whitney S Rice
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, Birmingham, AL, USA.
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street, Toronto, ON, Canada.
| | - Tessa M Napoles
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Melonie Walcott
- School of Health Sciences, The Sage Colleges, Albany, NY, USA.
| | | | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, USA.
| | - Gina M Wingood
- Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, USA.
| | - Deborah J Konkle-Parker
- Department of Medicine and School of Nursing, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, USA.
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, Birmingham, AL, USA.
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Medical Center, School of Public Health, Brooklyn, NY, USA.
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Janet M Turan
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, USA.
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Palar K, Wong MD, Cunningham WE. Competing subsistence needs are associated with retention in care and detectable viral load among people living with HIV. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2018; 17:163-179. [PMID: 30505245 PMCID: PMC6261356 DOI: 10.1080/15381501.2017.1407732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Competing priorities between subsistence needs and health care may interfere with HIV health. Longitudinal data from the Los Angeles-based HIV Outreach Initiative were analyzed to examine the association between competing subsistence needs and indicators of poor retention-in-care among hard-to-reach people with HIV. Sacrificing basic needs for health care in the previous six months was associated with a 1.55 times greater incidence of missed appointments (95% CI 1.17, 2.05), 2.32 times greater incidence of emergency department visits (95% CI 1.39, 3.87), 3.66 times greater incidence of not receiving ART if CD4 < 350 (95% CI 1.60, 8.37), and 1.35 times greater incidence of detectable viral load (95% CI 1.07, 1.70) (all p < 0.01). Among hard-to-reach PLHIV, sacrificing basic needs for health care delineates a population with exceptional vulnerability to poor outcomes along the HIV treatment cascade. Efforts to identify and reduce competing needs for this population are crucial to HIV health outcomes.
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Affiliation(s)
- Kartika Palar
- Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Mitchell D. Wong
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - William E. Cunningham
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA, Los Angeles, CA, USA
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17
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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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Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care. J Acquir Immune Defic Syndr 2017; 73:39-46. [PMID: 27028501 DOI: 10.1097/qai.0000000000001014] [Citation(s) in RCA: 266] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND It is unknown if a survival gap remains between HIV-infected and HIV-uninfected individuals with access to care. METHODS We conducted a cohort study within Kaiser Permanente California during 1996-2011, using abridged life tables to estimate the expected years of life remaining ("life expectancy") at age 20. RESULTS Among 24,768 HIV-infected and 257,600 HIV-uninfected individuals, there were 2229 and 4970 deaths, with mortality rates of 1827 and 326 per 100,000 person-years, respectively. In 1996-1997, life expectancies at age 20 for HIV-infected and HIV-uninfected individuals were 19.1 and 63.4 years, respectively, corresponding with a gap of 44.3 years (95% confidence interval: 38.4 to 50.2). Life expectancy at age 20 for HIV-infected individuals increased to 47.1 years in 2008 and 53.1 years by 2011, narrowing the gap to 11.8 years (8.9-14.8 years) in 2011. In 2008-2011, life expectancies at age 20 for HIV-infected individuals ranged from a low of 45.8 years for blacks and 46.0 years for those with a history of injection drug use to a high of 52.2 years for Hispanics. HIV-infected individuals who initiated antiretroviral therapy with CD4 ≥500 cells per microliter had a life expectancy at age 20 of 54.5 years in 2008-2011, narrowing the gap relative to HIV-uninfected individuals to 7.9 years (5.1-10.6 years). For these HIV-infected individuals, the gap narrowed further in subgroups with no history of hepatitis B or C infection, smoking, drug/alcohol abuse, or any of these risk factors. CONCLUSIONS Even with early treatment and access to care, an 8-year gap in life expectancy remains for HIV-infected compared with HIV-uninfected individuals.
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Rust G, Zhang S, Yu Z, Caplan L, Jain S, Ayer T, McRoy L, Levine RS. Counties eliminating racial disparities in colorectal cancer mortality. Cancer 2016; 122:1735-48. [PMID: 26969874 DOI: 10.1002/cncr.29958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/31/2015] [Accepted: 01/25/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although colorectal cancer (CRC) mortality rates are declining, racial-ethnic disparities in CRC mortality nationally are widening. Herein, the authors attempted to identify county-level variations in this pattern, and to characterize counties with improving disparity trends. METHODS The authors examined 20-year trends in US county-level black-white disparities in CRC age-adjusted mortality rates during the study period between 1989 and 2010. Using a mixed linear model, counties were grouped into mutually exclusive patterns of black-white racial disparity trends in age-adjusted CRC mortality across 20 three-year rolling average data points. County-level characteristics from census data and from the Area Health Resources File were normalized and entered into a principal component analysis. Multinomial logistic regression models were used to test the relation between these factors (clusters of related contextual variables) and the disparity trend pattern group for each county. RESULTS Counties were grouped into 4 disparity trend pattern groups: 1) persistent disparity (parallel black and white trend lines); 2) diverging (widening disparity); 3) sustained equality; and 4) converging (moving from disparate outcomes toward equality). The initial principal component analysis clustered the 82 independent variables into a smaller number of components, 6 of which explained 47% of the county-level variation in disparity trend patterns. CONCLUSIONS County-level variation in social determinants, health care workforce, and health systems all were found to contribute to variations in cancer mortality disparity trend patterns from 1990 through 2010. Counties sustaining equality over time or moving from disparities to equality in cancer mortality suggest that disparities are not inevitable, and provide hope that more communities can achieve optimal and equitable cancer outcomes for all. Cancer 2016;122:1735-48. © 2016 American Cancer Society.
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Affiliation(s)
- George Rust
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL.,Department of Community Health And Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Shun Zhang
- Statistics and Methodology Department, NORC at the University of Chicago, Chicago, Illinois
| | - Zhongyuan Yu
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, New Jersey
| | - Lee Caplan
- Deparment of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Sanjay Jain
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Turgay Ayer
- Department of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Luceta McRoy
- School of Business and Management, Southern Adventist University, Collegedale, Tennessee
| | - Robert S Levine
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
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20
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Rust G, Zhang S, Malhotra K, Reese L, McRoy L, Baltrus P, Caplan L, Levine RS. Paths to health equity: Local area variation in progress toward eliminating breast cancer mortality disparities, 1990-2009. Cancer 2015; 121:2765-74. [PMID: 25906833 PMCID: PMC4540479 DOI: 10.1002/cncr.29405] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/06/2015] [Accepted: 03/10/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND US breast cancer deaths have been declining since 1989, but African American women are still more likely than white women to die of breast cancer. Black/white disparities in breast cancer mortality rate ratios have actually been increasing. METHODS Across 762 US counties with enough deaths to generate reliable rates, county-level, age-adjusted breast cancer mortality rates were examined for women who were 35 to 74 years old during the period of 1989-2010. Twenty-two years of mortality data generated twenty 3-year rolling average data points, each centered on a specific year from 1990 to 2009. Mixed linear models were used to group each county into 1 of 4 mutually exclusive trend patterns. The most recent 3-year average black breast cancer mortality rate for each county was also categorized as being worse or not worse than the breast cancer mortality rate for the total US population. RESULTS More than half of the counties (54%) showed persistent, unchanging disparities. Roughly 1 in 4 (24%) had a divergent pattern of worsening black/white disparities. However, 10.5% of the counties sustained racial equality over the 20-year period, and 11.7% of the counties actually showed a converging pattern from high disparities to greater equality. Twenty-three counties had 2008-2010 black mortality rates better than the US average mortality rate. CONCLUSIONS Disparities are not inevitable. Four US counties have sustained both optimal and equitable black outcomes as measured by both absolute (better than the US average) and relative benchmarks (equality in the local black/white rate ratio) for decades, and 6 counties have shown a path from disparities to health equity.
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Affiliation(s)
- George Rust
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Shun Zhang
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Khusdeep Malhotra
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Leroy Reese
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Luceta McRoy
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
| | - Peter Baltrus
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Lee Caplan
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Robert S Levine
- Department of Family & Community Medicine, Meharry Medical College, Nashville, TN
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21
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Allgood KL, Hunt B, Rucker MG. Black:White Disparities in HIV Mortality in the United States: 1990-2009. J Racial Ethn Health Disparities 2015; 3:168-75. [PMID: 26896117 DOI: 10.1007/s40615-015-0141-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/22/2015] [Accepted: 06/11/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to assess whether racial disparities in human immunodeficiency virus (HIV) mortality in the USA have changed over time. METHODS Using vital records from the National Center for Health Statistics and census data from the US Census Bureau, we calculated the race- and gender-specific HIV mortality rates and corresponding racial rate ratios for non-Hispanic Blacks and non-Hispanic Whites in the USA for four 5-year increments from 1990-2009. Rates were age-adjusted using the 2000 USA standard population. Additionally, we calculated excess Black deaths for 2005-2009. RESULTS For the total, male, and female populations, we observed a statistically significant increase in the Black:White HIV mortality disparity between T1 (1990-1994) and T4 (2005-2009). The increasing disparity was due to the fact that the decrease in mortality rates from T1 to T4 was greater among Whites than Blacks. This disparity led to 5603 excess Black deaths in the USA at T4. CONCLUSIONS Previous research suggests that as HIV becomes more treatable, racial disparities widen, as observed in this study for both men and women. Existing disparities could be ameliorated if access to care were equal among these groups. Equal access would enable more individuals to achieve viral suppression, the final step of the HIV Care Continuum.
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Affiliation(s)
- Kristi L Allgood
- Sinai Urban Health Institute, Sinai Health System, 1500 S. Fairfield Avenue, K449, Chicago, IL, 60608, USA.
| | - Bijou Hunt
- Sinai Urban Health Institute, Sinai Health System, 1500 S. Fairfield Avenue, K449, Chicago, IL, 60608, USA
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22
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Baxi SM, Greenblatt RM, Bacchetti P, Jin C, French AL, Keller MJ, Augenbraun MH, Gange SJ, Liu C, Mack WJ, Gandhi M. Nevirapine Concentration in Hair Samples Is a Strong Predictor of Virologic Suppression in a Prospective Cohort of HIV-Infected Patients. PLoS One 2015; 10:e0129100. [PMID: 26053176 PMCID: PMC4460031 DOI: 10.1371/journal.pone.0129100] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/05/2015] [Indexed: 01/03/2023] Open
Abstract
Effective antiretroviral (ARV) therapy depends on adequate drug exposure, yet methods to assess ARV exposure are limited. Concentrations of ARV in hair are the product of steady-state pharmacokinetics factors and longitudinal adherence. We investigated nevirapine (NVP) concentrations in hair as a predictor of treatment response in women receiving ARVs. In participants of the Women’s Interagency HIV Study, who reported NVP use for >1 month from 2003–2008, NVP concentrations in hair were measured via liquid-chromatography-tandem mass-spectrometry. The outcome was virologic suppression (plasma HIV RNA below assay threshold) at the time of hair sampling and the primary predictor was nevirapine concentration categorized into quartiles. We controlled for age, race/ethnicity, pre-treatment HIV RNA, CD4 cell count, and self-reported adherence over the 6-month visit interval (categorized ≤ 74%, 75%–94% or ≥ 95%). We also assessed the relation of NVP concentration with changes in hepatic transaminase levels via multivariate random intercept logistic regression and linear regression analyses. 271 women contributed 1089 person-visits to the analysis (median 3 of semi-annual visits). Viral suppression was least frequent in concentration quartile 1 (86/178 (48.3%)) and increased in higher quartiles (to 158/204 (77.5%) for quartile 4). The odds of viral suppression in the highest concentration quartile were 9.17 times (95% CI 3.2–26, P < 0.0001) those in the lowest. African-American race was associated with lower rates of virologic suppression independent of NVP hair concentration. NVP concentration was not significantly associated with patterns of serum transaminases. Concentration of NVP in hair was a strong independent predictor of virologic suppression in women taking NVP, stronger than self-reported adherence, but did not appear to be strongly predictive of hepatotoxicity.
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Affiliation(s)
- Sanjiv M. Baxi
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- School of Public Health, Division of Epidemiology, University of California, Berkeley, California, United States of America
- * E-mail:
| | - Ruth M. Greenblatt
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Audrey L. French
- CORE Center and Division of Infectious Diseases, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States of America
| | - Marla J. Keller
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Michael H. Augenbraun
- Division of Infectious Diseases, State University of New York, Downstate Medical Center, Brooklyn, New York, United States of America
| | - Stephen J. Gange
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Chenglong Liu
- Department of Medicine, Georgetown University Medical Center, Washington DC, United States of America
| | - Wendy J. Mack
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Monica Gandhi
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
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23
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Juarez PD, Matthews-Juarez P, Hood DB, Im W, Levine RS, Kilbourne BJ, Langston MA, Al-Hamdan MZ, Crosson WL, Estes MG, Estes SM, Agboto VK, Robinson P, Wilson S, Lichtveld MY. The public health exposome: a population-based, exposure science approach to health disparities research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:12866-95. [PMID: 25514145 PMCID: PMC4276651 DOI: 10.3390/ijerph111212866] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/12/2014] [Accepted: 11/27/2014] [Indexed: 11/16/2022]
Abstract
The lack of progress in reducing health disparities suggests that new approaches are needed if we are to achieve meaningful, equitable, and lasting reductions. Current scientific paradigms do not adequately capture the complexity of the relationships between environment, personal health and population level disparities. The public health exposome is presented as a universal exposure tracking framework for integrating complex relationships between exogenous and endogenous exposures across the lifespan from conception to death. It uses a social-ecological framework that builds on the exposome paradigm for conceptualizing how exogenous exposures "get under the skin". The public health exposome approach has led our team to develop a taxonomy and bioinformatics infrastructure to integrate health outcomes data with thousands of sources of exogenous exposure, organized in four broad domains: natural, built, social, and policy environments. With the input of a transdisciplinary team, we have borrowed and applied the methods, tools and terms from various disciplines to measure the effects of environmental exposures on personal and population health outcomes and disparities, many of which may not manifest until many years later. As is customary with a paradigm shift, this approach has far reaching implications for research methods and design, analytics, community engagement strategies, and research training.
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Affiliation(s)
- Paul D Juarez
- Research Center on Health Disparities, Equity, and the Exposome, University of Tennessee Health Science Center, 66 N. Pauline, Memphis, TN 38105, USA.
| | - Patricia Matthews-Juarez
- Research Center on Health Disparities, Equity, and the Exposome, University of Tennessee Health Science Center, 66 N. Pauline, Memphis, TN 38105, USA.
| | - Darryl B Hood
- Department of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, OH 43210, USA.
| | - Wansoo Im
- Vertices, Inc., 317 George Street 411, New Brunswick, NJ 08901, USA.
| | - Robert S Levine
- Department of Family & Community Medicine, Meharry Medical College, Nashville, TN 37208, USA.
| | - Barbara J Kilbourne
- Department of Sociology, Tennessee State University, Nashville, TN 37209, USA.
| | - Michael A Langston
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA.
| | - Mohammad Z Al-Hamdan
- National Space Science and Technology Center, Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL 35805, USA.
| | - William L Crosson
- National Space Science and Technology Center, Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL 35805, USA.
| | - Maurice G Estes
- National Space Science and Technology Center, University of Alabama, Huntsville, AL 35805, USA.
| | - Sue M Estes
- National Space Science and Technology Center, Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL 35805, USA.
| | - Vincent K Agboto
- Department of Family & Community Medicine, Meharry Medical College, Nashville, TN 37208, USA.
| | - Paul Robinson
- Department of Ophthalmology, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
| | - Sacoby Wilson
- Research Center on Health Disparities, Equity, and the Exposome, University of Tennessee Health Science Center, 66 N. Pauline, Memphis, TN 38105, USA.
| | - Maureen Y Lichtveld
- Research Center on Health Disparities, Equity, and the Exposome, University of Tennessee Health Science Center, 66 N. Pauline, Memphis, TN 38105, USA.
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Fennie KP, Lutfi K, Maddox LM, Lieb S, Trepka MJ. Influence of residential segregation on survival after AIDS diagnosis among non-Hispanic blacks. Ann Epidemiol 2014; 25:113-9, 119.e1. [PMID: 25542342 DOI: 10.1016/j.annepidem.2014.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/29/2014] [Accepted: 11/04/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Non-Hispanic blacks (NHBs) are disproportionately affected by the AIDS epidemic. With the advent of highly active antiretroviral therapy (HAART), survival after AIDS diagnosis has increased dramatically, yet survival among NHBs is shorter compared with non-Hispanic whites. Racial residential segregation may be an important factor influencing observed racial disparities in survival. METHODS We linked data on 30,813 NHBs from the Florida Department of Health HIV/AIDS Reporting system (1993-2004) with death records and applied segregation indices and poverty levels to the data. Weighted Cox models were used to examine the association between segregation measured on five dimensions and survival, controlling for demographic factors, clinical factors, and area-level poverty. Analyses were stratified by pre-HAART (1993-1995), early HAART (1996-1998), and late-HAART (1999-2004) eras. RESULTS In the late-HAART era, adjusting for area-level poverty, segregation remained a significant predictor of survival on two dimensions: Concentration (hazard ratio, 1.32; 95% confidence interval, 1.13-1.56) and centralization (hazard ratio, 1.44; 95% confidence interval, 1.12-1.84). Area-level poverty was an independent predictor of survival. CONCLUSIONS These findings suggest that certain dimensions of segregation and poverty are associated with survival after AIDS diagnosis.
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Affiliation(s)
- Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami.
| | - Khaleeq Lutfi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami
| | - Lorene M Maddox
- Florida Consortium for HIV/AIDS Research/The AIDS Institute, Tampa
| | - Spencer Lieb
- HIV/AIDS Section, Florida Department of Health, Tallahassee
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami
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Exploration of preterm birth rates using the public health exposome database and computational analysis methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:12346-66. [PMID: 25464130 PMCID: PMC4276617 DOI: 10.3390/ijerph111212346] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/12/2014] [Accepted: 11/19/2014] [Indexed: 01/19/2023]
Abstract
Recent advances in informatics technology has made it possible to integrate, manipulate, and analyze variables from a wide range of scientific disciplines allowing for the examination of complex social problems such as health disparities. This study used 589 county-level variables to identify and compare geographical variation of high and low preterm birth rates. Data were collected from a number of publically available sources, bringing together natality outcomes with attributes of the natural, built, social, and policy environments. Singleton early premature county birth rate, in counties with population size over 100,000 persons provided the dependent variable. Graph theoretical techniques were used to identify a wide range of predictor variables from various domains, including black proportion, obesity and diabetes, sexually transmitted infection rates, mother’s age, income, marriage rates, pollution and temperature among others. Dense subgraphs (paracliques) representing groups of highly correlated variables were resolved into latent factors, which were then used to build a regression model explaining prematurity (R-squared = 76.7%). Two lists of counties with large positive and large negative residuals, indicating unusual prematurity rates given their circumstances, may serve as a starting point for ways to intervene and reduce health disparities for preterm births.
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Grant PM, Komarow L, Sanchez A, Sattler FR, Asmuth DM, Pollard RB, Zolopa AR. Clinical and immunologic predictors of death after an acute opportunistic infection: results from ACTG A5164. HIV CLINICAL TRIALS 2014; 15:133-9. [PMID: 25143022 DOI: 10.1310/hct1504-133] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In the pre-antiretroviral therapy (ART) era, markers of increased disease severity during an acute opportunistic infection (OI) were associated with mortality. Even with ART, mortality remains high during the first year after an OI in persons with advanced HIV infection, but it is unclear whether previous predictors of mortality remain valid in the current era. OBJECTIVE To determine clinical and immunological predictors of death after an OI. METHODS We used clinical data and stored plasma from ACTG A5164, a multicenter study evaluating the optimal timing of ART during a nontuberculous OI. We developed Cox models evaluating associations between clinical parameters and plasma marker levels at entry and time to death over the first 48 weeks after the diagnosis of OI. We developed multivariable models incorporating only clinical parameters, only plasma marker levels, or both. RESULTS The median CD4+ T-cell count in study participants at baseline was 29 cells/µL. Sixty-four percent of subjects had Pneumocystis jirovecii pneumonia (PCP). Twenty-three of 282 (8.2%) subjects died. In univariate analyses, entry mycobacterial infection, OI number, hospitalization, low albumin, low hemoglobin, lower CD4, and higher IL-8 and sTNFrII levels and lower IL-17 levels were associated with mortality. In the combined model using both clinical and immunologic parameters, the presence of an entry mycobacterial infection and higher sTNFrII levels were significantly associated with death. CONCLUSIONS In the ART era, clinical risk factors for death previously identified in the pre-ART era remain predictive. Additionally, activation of the innate immune system is associated with an increased risk of death following an acute OI.
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Price V, Swanson B, Phillips J, Swartwout K, Fog L, Jegier B. Factors Associated With Hospitalizations Among HIV-Infected Adults in the United States: Review of the Literature. West J Nurs Res 2014; 38:79-95. [PMID: 25112486 DOI: 10.1177/0193945914546202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although improving health outcomes in human immunodeficiency virus (HIV)-infected persons has been identified as a national priority, little is known about the factors associated with hospitalizations of HIV-infected persons in the highly active antiretroviral therapy (HAART) era. Since the introduction of HAART in 1996, there has been a dramatic increase in the life expectancy of HIV-infected persons. However, aging and the long term use of HIV medications have led to an increased incidence of chronic, non-HIV-related illnesses. To improve patient outcomes, the factors that contribute to co-morbidities in HIV-infected persons need to be identified. As a first step, we will summarize the current literature on causes and contributing factors of hospitalizations in adults infected with HIV in the HAART era.
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Westerling R, Westin M, McKee M, Hoffmann R, Plug I, Rey G, Jougla E, Lang K, Pärna K, Alfonso JL, Mackenbach JP. The timing of introduction of pharmaceutical innovations in seven European countries. J Eval Clin Pract 2014; 20:301-10. [PMID: 24750393 PMCID: PMC4282430 DOI: 10.1111/jep.12122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Differences in the performance of medical care may be due to variation in the introduction and diffusion of medical innovations. The objective of this paper is to compare seven European countries (United Kingdom, the Netherlands, West Germany, France, Spain, Estonia and Sweden) with regard to the year of introduction of six specific pharmaceutical innovations (antiretroviral drugs, cimetidine, tamoxifen, cisplatin, oxalaplatin and cyclosporin) that may have had important population health impacts. METHODS We collected information on introduction and further diffusion of drugs using searches in the national and international literature, and questionnaires to national informants. We combined various sources of information, both official years of registration and other indicators of introduction (clinical trials, guidelines, evaluation reports, sales statistics). RESULTS AND CONCLUSIONS The total length of the period between first and last introduction varied between 8 years for antiretroviral drugs and 22 years for cisplatin. Introduction in Estonia was generally delayed until the 1990s. The average time lags were smallest in France (2.2 years), United Kingdom (2.8 years) and the Netherlands (3.5 years). Similar rank orders were seen for year of registration suggesting that introduction lags are not only explained by differences in the process of registration. We discuss possible reasons for these between-country differences and implications for the evaluation of medical care.
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Affiliation(s)
| | - Marcus Westin
- Research Physician, Department of Public Health and caring sciences, Social Medicine, Uppsala University, BMCUppsala, Sweden
| | - Martin McKee
- Professor, London School of Hygiene & Tropical MedicineLondon, UK
| | | | | | - Grégoire Rey
- Director, INSERM CépiDc44, chemin de Ronde, Paris, France
| | - Eric Jougla
- Director, INSERM CépiDc44, chemin de Ronde, Paris, France
| | - Katrin Lang
- Associate Professor, Department of Public Health, University of TartuTartu, Estonia
| | - Kersti Pärna
- Associate Professor, Department of Public Health, University of TartuTartu, Estonia
| | - José L Alfonso
- Professor, Department of Preventive Medicine and Public Health, University of ValenciaValencia, Spain
| | - Johan P Mackenbach
- Professor, Department of Public Health, Erasmus Medical CenterRotterdam, The Netherlands
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Elo IT, Beltrán-Sánchez H, Macinko J. The Contribution of Health Care and Other Interventions to Black-White Disparities in Life Expectancy, 1980-2007. POPULATION RESEARCH AND POLICY REVIEW 2014; 33:97-126. [PMID: 24554793 PMCID: PMC3925638 DOI: 10.1007/s11113-013-9309-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Black-white mortality disparities remain sizable in the United States. In this study, we use the concept of avoidable/amenable mortality to estimate cause-of-death contributions to the difference in life expectancy between whites and blacks by gender in the United States in 1980, 1993, and 2007. We begin with a review of the concept of "avoidable mortality" and results of prior studies using this cause-of-death classification. We then present the results of our empirical analyses. We classified causes of death as amenable to medical care, sensitive to public health policies and health behaviors, ischemic heart disease, suicide, HIV/AIDS, and all other causes combined. We used vital statistics data on deaths and Census Bureau population estimates and standard demographic decomposition techniques. In 2007, causes of death amenable to medical care continued to account for close to 2 years of the racial difference in life expectancy among men (2.08) and women (1.85). Causes amenable to public health interventions made a larger contribution to the racial difference in life expectancy among men (1.17 years) than women (0.08 years). The contribution of HIV/AIDS substantially widened the racial difference among both men (1.08 years) and women (0.42 years) in 1993, but its contribution declined over time. Despite progress observed over the time period studied, a substantial portion of black-white disparities in mortality could be reduced given more equitable access to medical care and health interventions.
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Affiliation(s)
- Irma T. Elo
- Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA
| | - Hiram Beltrán-Sánchez
- Center for Demography and Ecology, University of Wisconsin, 4329 Sewell Social Science, Madison, WI, USA
| | - James Macinko
- New York University, 411 Lafayette Street 5th Floor, New York, NY 10003, USA
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Educational attainment and risk of HIV infection, response to antiretroviral treatment, and mortality in HIV-infected patients. AIDS 2014; 28:387-96. [PMID: 24670524 DOI: 10.1097/qad.0000000000000032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To estimate association between educational attainment and risk of HIV diagnosis, response to HAART, all-cause, and cause-specific mortality in Denmark in 1998-2009. DESIGN Prospective, population-based cohort study including 1277 incident HIV-infected patients without hepatitis C virus or intravenous drug abuse identified in the Danish HIV Cohort Study and 5108 individually matched population controls. METHODS Data on educational attainment, categorized as low, medium, or high, were identified in The Danish Attainment Register. Logistic and Poisson regression were used to estimate odds ratios (ORs) and mortality rate ratios (MRRs). RESULTS OR of HIV diagnosis was 1.7 (95% confidence interval, CI 1.3-2.3) among heterosexual individuals with low educational attainments, but no associations between educational attainment and time to HAART initiation, CD4 cell count, or viral suppression were identified. All-cause MRRs were 1.8 (95% CI 1.0-3.2) and 1.8 (1.1-2.8) for HIV-infected patients and population controls with low educational attainment compared with medium and high educational attainment. MRRs for smoking and alcohol-related deaths were 3.6 (95% CI 1.5-8.9) for HIV-infected patients and 2.0 (95% CI 1.2-3.4) for population controls with low educational attainment compared with medium and high educational attainment. CONCLUSION With free and equal access to healthcare, low educational attainment might increase risk of HIV infection among heterosexual individuals, but was not associated with late/very late presentation of HIV, time to HAART initiation, or HAART response. However, low educational attainment substantially increased lifestyle-related mortality, which indicates that increased mortality in HIV-infected patients with low educational attainments stems from risk factors unrelated to HIV.
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McFall AM, Dowdy DW, Zelaya CE, Murphy K, Wilson TE, Young MA, Gandhi M, Cohen MH, Golub ET, Althoff KN. Understanding the disparity: predictors of virologic failure in women using highly active antiretroviral therapy vary by race and/or ethnicity. J Acquir Immune Defic Syndr 2013; 64:289-98. [PMID: 23797695 PMCID: PMC3816935 DOI: 10.1097/qai.0b013e3182a095e9] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stark racial/ethnic disparities in health outcomes exist among those living with HIV in the United States. One of 3 primary goals of the National HIV/AIDS Strategy is to reduce HIV-related disparities and health inequities. METHODS Using data from HIV-infected women participating in the Women's Interagency HIV Study from April 2006 to March 2011, we measured virologic failure (HIV RNA >200 copies/mL) after suppression (HIV RNA < 80 copies/mL) on highly active antiretroviral therapy. We identified predictors of virologic failure using discrete time survival analysis and calculated racial/ethnic-specific population-attributable fractions (PAFs). RESULTS Of 887 eligible women, 408 (46%) experienced virologic failure during the study period. Hispanic and white women had significantly lower hazards of virologic failure than African American women [Hispanic hazard ratio, (HR) = 0.8, 95% confidence interval: (0.6 to 0.9); white HR = 0.7 (0.5 to 0.9)]. The PAF of virologic failure associated with low income was higher in Hispanic [adjusted hazard ratios (aHR) = 2.2 (0.7 to 6.5), PAF = 49%] and African American women [aHR = 1.8 (1.1 to 3.2), PAF = 38%] than among white women [aHR = 1.4 (0.6 to 3.4), PAF = 16%]. Lack of health insurance compared with public health insurance was associated with virologic failure only among Hispanic [aHR = 2.0 (0.9 to 4.6), PAF = 22%] and white women [aHR = 1.9 (0.7 to 5.1), PAF = 13%]. By contrast, depressive symptoms were associated with virologic failure only among African-American women [aHR = 1.6 (1.2 to 2.2), PAF = 17%]. CONCLUSIONS In this population of treated HIV-infected women, virologic failure was common, and correlates of virologic failure varied by race/ethnicity. Strategies to reduce disparities in HIV treatment outcomes by race/ethnicity should address racial/ethnic-specific barriers including depression and low income to sustain virologic suppression.
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Affiliation(s)
- Allison M. McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - David W. Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - Carla E. Zelaya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - Kerry Murphy
- Department of Medicine/Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, US
| | - Tracey E. Wilson
- Department of Community Health Sciences, State University of New York Downstate Medical Center, Brooklyn, NY, US
| | - Mary A. Young
- Department of Medicine, Georgetown University Medical Center, Washington, DC, US
| | - Monica Gandhi
- Department of Medicine, University of California, San Francisco, San Francisco, CA, US
| | - Mardge H. Cohen
- Department of Medicine and the CORE Center, Cook County Health and Hospitals System and Rush University, Chicago, IL, US
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
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Zhang S, Senteio C, Felizzola J, Rust G. Racial/ethnic disparities in antiretroviral treatment among HIV-infected pregnant Medicaid enrollees, 2005-2007. Am J Public Health 2013; 103:e46-53. [PMID: 24134365 DOI: 10.2105/ajph.2013.301328] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined racial/ethnic differences in prenatal antiretroviral (ARV) treatment among 3259 HIV-infected pregnant Medicaid enrollees. METHODS We analyzed 2005-2007 Medicaid claims data from 14 southern states, comparing rates of not receiving ARVs and suboptimal versus optimal ARV therapy. RESULTS More than one third (37.3%) had zero claims for ARV drugs. Three quarters (73.4%) of 346 Hispanic women received no prenatal ARVs. After we adjusted for covariates, Hispanic women had 3.89 (95% confidence interval = 2.58, 5.87) times the risk of not receiving ARVs compared with Whites. Hispanic women often had only 1 or 2 months of Medicaid eligibility, perhaps associated with barriers for immigrants. Less than 3 months of eligibility was strongly associated with nontreatment (adjusted odds ratio = 29.0; 95% confidence interval = 13.4, 62.7). CONCLUSIONS Optimal HIV treatment rates in pregnancy are a public health priority, especially for preventing transmission to infants. Medicaid has the surveillance and drug coverage to ensure that all HIV-infected pregnant women are offered treatment. States that offer emergency Medicaid coverage for only delivery services to pregnant immigrants are missing an opportunity to screen, diagnose, and treat pregnant women with HIV, and to prevent HIV in children.
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Affiliation(s)
- Shun Zhang
- Shun Zhang and George Rust are with the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA. Charles Senteio is with the University of Michigan, School of Information, Ann Arbor. Jesus Felizzola is with the AIDS Education and Training Center, National Center for HIV Care in Minority Communities, HealthHIV, Washington, DC
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King NB, Harper S, Young ME. Who cares about health inequalities? Cross-country evidence from the World Health Survey. Health Policy Plan 2013; 28:558-71. [PMID: 23059735 PMCID: PMC3743307 DOI: 10.1093/heapol/czs094] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2012] [Indexed: 11/13/2022] Open
Abstract
Reduction of health inequalities within and between countries is a global health priority, but little is known about the determinants of popular support for this goal. We used data from the World Health Survey to assess individual preferences for prioritizing reductions in health and health care inequalities. We used descriptive tables and regression analysis to study the determinants of preferences for reducing health inequalities as the primary health system goal. Determinants included individual socio-demographic characteristics (age, sex, urban residence, education, marital status, household income, self-rated health, health care use, satisfaction with health care system) and country-level characteristics [gross domestic product (GDP) per capita, disability-free life expectancy, equality in child mortality, income inequality, health and public health expenditures]. We used logistic regression to assess the likelihood that individuals ranked minimizing inequalities first, and rank-ordered logistic regression to compare the ranking of other priorities against minimizing health inequalities. Individuals tended to prioritize health system goals related to overall improvement (improving population health and health care responsiveness) over those related to equality and fairness (minimizing inequalities in health and responsiveness, and promoting fairness of financial contribution). Individuals in countries with higher GDP per capita, life expectancy, and equality in child mortality were more likely to prioritize minimizing health inequalities.
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Affiliation(s)
- Nicholas B King
- McGill University, 3647 Peel St., Montreal, QC H3A 1X1, Canada.
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Harper S, King NB, Young ME. Impact of selective evidence presentation on judgments of health inequality trends: an experimental study. PLoS One 2013; 8:e63362. [PMID: 23696818 PMCID: PMC3656043 DOI: 10.1371/journal.pone.0063362] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 04/01/2013] [Indexed: 11/18/2022] Open
Abstract
Reducing health inequalities is a key objective for many governments and public health organizations. Whether inequalities are measured on the absolute (difference) or relative (ratio) scale can have a significant impact on judgments about whether health inequalities are increasing or decreasing, but both of these measures are not often presented in empirical studies. In this study we investigated the impact of selective presentation of health inequality measures on judgments of health inequality trends among 40 university undergraduates. We randomized participants to see either a difference or ratio measure of health inequality alongside raw mortality rates in 5 different scenarios. At baseline there were no differences between treatment groups in assessments of inequality trends, but selective exposure to the same raw data augmented with ratio versus difference inequality graphs altered participants’ assessments of inequality change. When absolute inequality decreased and relative inequality increased, exposure to ratio measures increased the probability of concluding that inequality had increased from 32.5% to 70%, but exposure to difference measures did not (35% vs. 25%). Selective exposure to ratio versus difference inequality graphs thus increased the difference between groups in concluding that inequality had increased from 2.5% (95% CI −9.5% to 14.5%) to 45% (95% CI 29.4 to 60.6). A similar pattern was evident for other scenarios where absolute and relative inequality trends gave conflicting results. In cases where measures of absolute and relative inequality both increased or both decreased, we did not find any evidence that assignment to ratio vs. difference graphs had an impact on assessments of inequality change. Selective reporting of measures of health inequality has the potential to create biased judgments of progress in ameliorating health inequalities.
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Affiliation(s)
- Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
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Widening Socioeconomic, Racial, and Geographic Disparities in HIV/AIDS Mortality in the United States, 1987-2011. Adv Prev Med 2013; 2013:657961. [PMID: 23738084 PMCID: PMC3664477 DOI: 10.1155/2013/657961] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/15/2013] [Indexed: 11/21/2022] Open
Abstract
This study examined the extent to which socioeconomic and racial and geographic disparities in HIV/AIDS mortality in the United States changed between 1987 and 2011. Census-based deprivation indices were linked to county-level mortality data from 1987 to 2009. Log-linear, least-squares, and Poisson regression were used to model mortality trends and differentials. HIV/AIDS mortality rose between 1987 and 1995 and then declined markedly for all groups between 1996 and 2011. Despite the steep mortality decline, socioeconomic gradients and racial and geographic disparities in HIV/AIDS mortality increased substantially during the study period. Compared to whites, blacks had 3 times higher HIV/AIDS mortality in 1987 and 8 times higher mortality in 2011. In 1987, those in the most-deprived group had 1.9 times higher HIV/AIDS mortality than those in the most-affluent group; the corresponding relative risks increased to 2.9 in 1998 and 3.6 in 2009. Socioeconomic gradients existed across all race-sex groups, with mortality risk being 8–16 times higher among blacks than whites within each deprivation group. Dramatic reductions in HIV/AIDS mortality represent a major public health success. However, slower mortality declines among more deprived groups and blacks contributed to the widening gap. Mortality disparities reflect inequalities in incidence, access to antiretroviral therapy, and patient survival.
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Saha S, Korthuis PT, Cohn JA, Sharp VL, Moore RD, Beach MC. Primary care provider cultural competence and racial disparities in HIV care and outcomes. J Gen Intern Med 2013; 28:622-9. [PMID: 23307396 PMCID: PMC3631054 DOI: 10.1007/s11606-012-2298-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 07/19/2012] [Accepted: 11/15/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health professional organizations have advocated for increasing the "cultural competence" (CC) of healthcare providers, to reduce racial and ethnic disparities in patient care. It is unclear whether provider CC is associated with more equitable care. OBJECTIVE To evaluate whether provider CC is associated with quality of care and outcomes for patients with HIV/AIDS. DESIGN AND PARTICIPANTS Survey of 45 providers and 437 patients at four urban HIV clinics in the U.S. MAIN MEASURES Providers' self-rated CC was measured using a novel, 20-item instrument. Outcome measures included patients' receipt of antiretroviral (ARV) therapy, self-efficacy in managing medication regimens, complete 3-day ARV adherence, and viral suppression. KEY RESULTS Providers' mean age was 44 years; 56 % were women, and 64 % were white. Patients' mean age was 45; 67 % were men, and 77 % were nonwhite. Minority patients whose providers scored in the middle or highest third on self-rated CC were more likely than those with providers in the lowest third to be on ARVs, have high self-efficacy, and report complete ARV adherence. Racial disparities were observed in receipt of ARVs (adjusted OR, 95 % CI for white vs. nonwhite: 6.21, 1.50-25.7), self-efficacy (3.77, 1.24-11.4), and viral suppression (13.0, 3.43-49.0) among patients of low CC providers, but not among patients of moderate and high CC providers (receipt of ARVs: 0.71, 0.32-1.61; self-efficacy: 1.14, 0.59-2.22; viral suppression: 1.20, 0.60-2.42). CONCLUSIONS Provider CC was associated with the quality and equity of HIV care. These findings suggest that enhancing provider CC may reduce racial disparities in healthcare quality and outcomes.
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Affiliation(s)
- Somnath Saha
- Section of General Internal Medicine, Portland VA Medical Center, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, USA.
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Smith KY. Addressing disparities in HIV mortality: antiretroviral therapy is necessary but not sufficient. Clin Infect Dis 2013; 56:1810-1. [PMID: 23457075 DOI: 10.1093/cid/cit116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Evans SD, Williams BE. Transportation-related barriers to care among African American women living with HIV/AIDS: "What you getting out of the cab for?". ONLINE JOURNAL OF RURAL AND URBAN RESEARCH 2013; 3:http://jsumurc.org/ojs/index.php?journal=ojrur&page=article&op=view&path%5B%5D=98. [PMID: 26523160 PMCID: PMC4624418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Transportation-related problems have been consistently reported as barriers to accessing and remaining in HIV medical care, particularly among African American women living in under-resourced areas. With emphasis on the Southern region of the United States, this commentary presents a brief overview of the HIV/AIDS epidemic among African Americans, barriers to remaining in HIV care, and pilot data from a study conducted among African American women living in Mississippi. A small focus group study was conducted to examine the relative influence of transportation-related barriers on attendance and motivation to attend HIV medical care appointments. Eight African American women (mean age of 43.50, SD = 10.82) who were engaged in medical care participated in one focus group session. Time since diagnosis ranged from 6 to 17 years. Participants reported transportation-related barriers that were generally consistent with previous research, including lack of personal transportation, limited financial resources to pay family and friends for transportation or gasoline, and inconveniences associated with sharing van services with other patients. Participants appeared to have learned how to successfully navigate these barriers in order to remain in care. Interestingly, participants reported significant fear of disclosure related to use of transportation services provided by insurance providers and community organizations. Specifically, many of the women indicated that family, friends, and neighbors questioned them about where they were going and why they used taxis. These types of encounters might influence whether individuals utilize available transportation services. Participants provided several recommendations for improving the transportation system. Additional research is warranted to obtain a more representative sampling of opinions among African American women living in under-resourced areas.
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Affiliation(s)
- Shenell D. Evans
- HIV Center for Clinical and Behavioral Studies, Columbia University
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King NB, Harper S, Young ME. Use of relative and absolute effect measures in reporting health inequalities: structured review. BMJ 2012; 345:e5774. [PMID: 22945952 PMCID: PMC3432634 DOI: 10.1136/bmj.e5774] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine the frequency of reporting of absolute and relative effect measures in health inequalities research. DESIGN Structured review of selected general medical and public health journals. DATA SOURCES 344 articles published during 2009 in American Journal of Epidemiology, American Journal of Public Health, BMJ, Epidemiology, International Journal of Epidemiology, JAMA, Journal of Epidemiology and Community Health, The Lancet, The New England Journal of Medicine, and Social Science and Medicine. MAIN OUTCOME MEASURES Frequency and proportion of studies reporting absolute effect measures, relative effect measures, or both in abstract and full text; availability of absolute risks in studies reporting only relative effect measures. RESULTS 40% (138/344) of articles reported a measure of effect in the abstract; among these, 88% (122/138) reported only a relative measure, 9% (13/138) reported only an absolute measure, and 2% (3/138) reported both. 75% (258/344) of all articles reported only relative measures in the full text; among these, 46% (119/258) contained no information on absolute baseline risks that would facilitate calculation of absolute effect measures. 18% (61/344) of all articles reported only absolute measures in the full text, and 7% (25/344) reported both absolute and relative measures. These results were consistent across journals, exposures, and outcomes. CONCLUSIONS Health inequalities are most commonly reported using only relative measures of effect, which may influence readers' judgments of the magnitude, direction, significance, and implications of reported health inequalities.
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Affiliation(s)
- Nicholas B King
- Biomedical Ethics Unit, McGill University Faculty of Medicine, 3647 Peel St, Montreal, QC, Canada H3A 1X1.
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Pavlova-McCalla E, Trepka MJ, Ramirez G, Niyonsenga T. Socioeconomic Status and Survival of People with Human Immunodeficiency Virus Infection before and after the Introduction of Highly Active Antiretroviral Therapy: A Systematic Literature Review. JOURNAL OF AIDS & CLINICAL RESEARCH 2012; 3:1000163. [PMID: 24575328 PMCID: PMC3933225 DOI: 10.4172/2155-6113.1000163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Human immunodeficiency virus/acquired immunodeficiency disease syndrome-associated mortality contributes considerably to overall mortality rates among adults in the United States. The purpose of this review is to systematically examine conceptual approaches that have been used to evaluate the association between socioeconomic status of people infected with human immunodeficiency virus and their survival and summarize existing evidence regarding the association between socioeconomic status and mortality due to human immunodeficiency virus/acquired immunodeficiency disease syndrome. METHODS We systematically retrieved neighborhood and individual-level studies of acquired immunodeficiency disease syndrome-related or all-cause mortality among patients diagnosed with human immunodeficiency virus that reported original data and analyzed socioeconomic status as a predictor of mortality. RESULTS We included 21 studies (19 cohort and 2 case-control studies). Heterogeneity in both the conceptual approaches to socioeconomic status measurements and selection of variables for the adjustment of the measure of association precluded meta-analysis of the results. Six studies observing populations before the introduction of highly active antiretroviral therapy found that socioeconomic status was not associated with human immunodeficiency virus/acquired immunodeficiency disease syndrome mortality. In the post- highly active antiretroviral therapy period socioeconomic status was inconsistently associated with Human immunodeficiency virus/acquired immunodeficiency disease syndrome mortality risk in studies adjusting for highly active antiretroviral therapy use. CONCLUSION Further studies considering multilevel socioeconomic status measurements and controlling for treatment and clinical variables are needed to enhance understanding of the role of socioeconomic gradients on human immunodeficiency virus outcomes.
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Affiliation(s)
- Elena Pavlova-McCalla
- Department of Epidemiology and Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology and Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Florida, USA
| | - Gilbert Ramirez
- Department of Health Policy and Management, Robert Stempel College of Public Health and Social Work, Florida International University, Florida, USA
| | - Theophile Niyonsenga
- Department of Epidemiology and Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Florida, USA
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Rust G, Levine RS, Fry-Johnson Y, Baltrus P, Ye J, Mack D. Paths to success: optimal and equitable health outcomes for all. J Health Care Poor Underserved 2012; 23:7-19. [PMID: 22643550 PMCID: PMC3601025 DOI: 10.1353/hpu.2012.0084] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract:U.S. health disparities are real, pervasive, and persistent, despite dramatic improvements in civil rights and economic opportunity for racial and ethnic minority and lower socioeconomic groups in the United States. Change is possible, however. Disparities vary widely from one community to another, suggesting that they are not inevitable. Some communities even show paradoxically good outcomes and relative health equity despite significant social inequities. A few communities have even improved from high disparities to more equitable and optimal health outcomes. These positive-deviance communities show that disparities can be overcome and that health equity is achievable. Research must shift from defining the problem (including causes and risk factors) to testing effective interventions, informed by the natural experiments of what has worked in communities that are already moving toward health equity. At the local level, we need multi-dimensional interventions designed in partnership with communities and continuously improved by rapid-cycle surveillance feedback loops of community-level disparities metrics. Similarly coordinated strategies are needed at state and national levels to take success to scale. We propose ten specific steps to follow on a health equity path toward optimal and equitable health outcomes for all Americans.
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Affiliation(s)
- George Rust
- National Center for Primary Care, Morehouse School of Medicine, 720 Westview Dr., Atlanta, GA 30310, USA.
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Oramasionwu CU, Brown CM, Lawson KA, Ryan L, Skinner J, Frei CR. Differences in national antiretroviral prescribing patterns between black and white patients with HIV/AIDS, 1996-2006. South Med J 2011; 104:794-800. [PMID: 22089356 PMCID: PMC3222681 DOI: 10.1097/smj.0b013e318236c23a] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The benefit of improved health outcomes for blacks receiving highly active antiretroviral therapy (HAART) lags behind that of whites. This project therefore sought to determine whether the reason for this discrepancy in health outcomes could be attributed to disparities in use of antiretroviral therapy between black and white patients with HIV. MATERIALS AND METHODS The 1996-2006 National Hospital Ambulatory Medical Care Surveys were used to identify hospital outpatient visits that documented antiretrovirals. Patients younger than 18 years, of nonblack or nonwhite race, and lacking documentation of antiretrovirals were excluded. A multivariable logistic regression model was constructed with race as the independent variable and use of HAART as the dependent variable. RESULTS Approximately 3 million HIV/AIDS patient visits were evaluated. Blacks were less likely than whites to use HAART and protease inhibitors (odds ratio, 95% CI 0.81 [0.81-0.82] and 0.67 [0.67-0.68], respectively). More blacks than whites used non-nucleoside reverse transcriptase inhibitors (odds ratio, 95% CI 1.18 [1.17-1.18]). In 1996, the crude rates of HAART were relatively low for both black and white cohorts (5% vs 6%). The rise in HAART for blacks appeared to lag behind that of whites for several years, until 2002, when the proportion of blacks receiving HAART slightly exceeded the proportion of whites receiving HAART. In later years, the rates of HAART were similar for blacks and whites (81% vs 82% in 2006). Blacks appeared less likely than whites to use protease inhibitors and more likely than whites to use non-nucleoside reverse transcriptase inhibitors from 2000 to 2004. CONCLUSIONS Blacks experienced a lag in the use of antiretrovirals at the beginning of the study; this discrepancy dissipated in more recent years.
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Nevin CR, Ye J, Aban I, Mugavero MJ, Jackson D, Lin HY, Allison J, Raper JL, Saag MS, Willig JH. The role of toxicity-related regimen changes in the development of antiretroviral resistance. AIDS Res Hum Retroviruses 2011; 27:957-63. [PMID: 21342052 DOI: 10.1089/aid.2010.0291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In an effort to evaluate factors associated with the development of antiretroviral (ARV) resistance, we assessed the prevalence of toxicity-related regimen changes and modeled its association to the subsequent development of ARV resistance in a cohort of treatment-naive individuals initiating ARV therapy (ART). A retrospective analysis of patients initiating ART was conducted at the UAB 1917 Clinic from 1 January 2000 to 30 September 2007. Cox proportional hazards models were fit to identify factors associated with the development of resistance to ≥1 ARV drug class. Among 462 eligible participants, 14% (n=64) developed ARV resistance. Individuals with ≥1 toxicity-related regimen change (HR=3.94, 95% CI=1.09-14.21), initiating ART containing ddI or d4T (4.12, 1.19-14.26), and from a minority race (2.91, 1.16-7.28) had increased risk of developing resistance. Achieving virologic suppression within 12 months of ART initiation (0.10, 0.05-0.20) and higher pretreatment CD4 count (0.85 per 50 cells/mm(3), 0.75-0.96) were associated with decreased hazards of resistance. Changes in ART due to drug intolerance were associated with the subsequent development of ARV resistance. Understanding the role of ARV drug selection and other factors associated with the emergence of ARV resistance will help inform interventions to improve patient care and ensure long-term treatment success.
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Affiliation(s)
- Christa R. Nevin
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jiatao Ye
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Inmaculada Aban
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael J. Mugavero
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - David Jackson
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hui-Yi Lin
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeroan Allison
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - James L. Raper
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael S. Saag
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - James H. Willig
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
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Abstract
Since the beginning of the AIDS epidemic, models of HIV care have needed to be invented or modified as the needs of patients and communities evolved. Early in the epidemic, primary care and palliative care predominated; subsequently, the emergence of effective therapy for HIV infection led to further specialization and a focus on increasingly complex antiretroviral therapy as the cornerstone of effective HIV care. Over the past decade, factors including (1) an aging, long-surviving population; (2) multiple co-morbidities; (3) polypharmacy; and (4) the need for chronic disease management have led to a need for further evolution of HIV care models. Moreover, geographic diffusion; persistent disparities in timely HIV diagnosis, treatment access, and outcomes; and the aging of the HIV provider workforce also suggest the importance of reincorporating primary care providers into the spectrum of HIV care in the current era. Although some HIV-dedicated treatment centers offer comprehensive medical services, other models of HIV care potentially exist and should be developed and evaluated. In particular, primary care- and community-based collaborative practices-where HIV experts or specialists are incorporated into existing health centers-are one approach that combines the benefits of HIV-specific expertise and comprehensive primary care using an integrated, patient-centered approach.
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Haile R, Padilla MB, Parker EA. 'Stuck in the quagmire of an HIV ghetto': the meaning of stigma in the lives of older black gay and bisexual men living with HIV in New York City. CULTURE, HEALTH & SEXUALITY 2011; 13:429-42. [PMID: 21229421 PMCID: PMC3053418 DOI: 10.1080/13691058.2010.537769] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In this paper, we analyse the life history narratives of 10 poor gay and bisexual Black men over the age of 50 living with HIV/AIDS in New York City, focusing on experiences of stigma. Three overarching themes are identified. First, participants described the ways in which stigma marks them as 'just one more body' within social and medical institutions, emphasising the dehumanisation they experience in these settings. Second, respondents described the process of 'knowing your place' within social hierarchies as a means through which they are rendered tolerable. Finally, interviewees described the dynamics of stigma as all-consuming, relegating them to the 'quagmire of an HIV ghetto'. These findings emphasise that despite advances in treatment and an aging population of persons living with HIV, entrenched social stigmas continue to endanger the well-being of Black men who have sex with men.
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Affiliation(s)
- Rahwa Haile
- HIV Center for Clinical and Behavioural Studies, Columbia University and NY State of Psychiatric Institute, New York, USA.
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King WD, Wyatt GE, Liu H, Williams JK, DiNardo AD, Mitsuyasu RT. Pilot assessment of HIV gene therapy-hematopoietic stem cell clinical trial acceptability among minority patients and their advisors. J Natl Med Assoc 2011; 102:1123-8. [PMID: 21287892 DOI: 10.1016/s0027-9684(15)30766-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Clinical trials involving technologically involved novel treatments such as gene therapy delivered through hematopoietic stem cells as human immunodeficiency virus (HIV) treatment will need to recruit ethnically diverse patients to ensure the acceptance among broad groups of individuals and generalizability of research findings. Five focus groups of 47 HIV-positive men and women, religious and community leaders and health providers, mostly from African American and low-income communities, were conducted to examine knowledge about gene therapy and stem cell research and to assess the moral and ethical beliefs that might influence participation in clinical trials. Three themes emerged from these groups: (1) the need for clarification of terminology and the ethics of understanding gene therapy-stem cell research, (2) strategies to avoid mistrust of medical procedures and provider mistrust, and (3) the conflict between science and religious beliefs as it pertains to gene therapy-stem cell research.
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Affiliation(s)
- William Douglas King
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
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Hodder SL, Justman J, Haley DF, Adimora AA, Fogel CI, Golin CE, O'Leary A, Soto-Torres L, Wingood G, El-Sadr WM. Challenges of a hidden epidemic: HIV prevention among women in the United States. J Acquir Immune Defic Syndr 2010; 55 Suppl 2:S69-73. [PMID: 21406990 PMCID: PMC3551266 DOI: 10.1097/qai.0b013e3181fbbdf9] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HIV/AIDS trends in the United States depict a concentrated epidemic with hot spots that vary by location, poverty, race/ethnicity, and transmission mode. HIV/AIDS is a leading cause of death among US women of color; two-thirds of new infections among women occur in black women, despite the fact that black women account for just 14% of the US female population. The gravity of the HIV epidemic among US women is often not appreciated by those at risk and by the broader scientific community. We summarize the current epidemiology of HIV/AIDS among US women and discuss clinical, research, and public health intervention components that must be brought together in a cohesive plan to reduce new HIV infections in US women. Only by accelerating research and programmatic efforts will the hidden epidemic of HIV among US women emerge into the light and come under control.
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Affiliation(s)
- Sally L Hodder
- University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA.
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Levine RS, Rust GS, Pisu M, Agboto V, Baltrus PA, Briggs NC, Zoorob R, Juarez P, Hull PC, Goldzweig I, Hennekens CH. Increased Black-White disparities in mortality after the introduction of lifesaving innovations: a possible consequence of US federal laws. Am J Public Health 2010; 100:2176-84. [PMID: 20864727 PMCID: PMC2951928 DOI: 10.2105/ajph.2009.170795] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored whether the introduction of 3 lifesaving innovations introduced between 1989 and 1996 increased, decreased, or had no effect on disparities in Black-White mortality in the United States through 2006. METHODS Centers for Disease Control and Prevention data were used to assess disease-, age-, gender-, and race-specific changes in mortality after the introduction of highly active anti-retroviral therapy (HAART) for treatment of HIV, surfactants for neonatal respiratory distress syndrome, and Medicare reimbursement of mammography screening for breast cancer. RESULTS Disparities in Black-White mortality from HIV significantly increased after the introduction of HAART, surfactant therapy, and reimbursement for screening mammography. Between 1989 and 2006, these circumstances may have accounted for an estimated 22,441 potentially avoidable deaths among Blacks. CONCLUSIONS These descriptive data contribute to the formulation of the hypothesis that federal laws promote increased disparities in Black-White mortality by inadvertently favoring Whites with respect to access to lifesaving innovations. Failure of legislation to address known social factors is a plausible explanation, at least in part, for the observed findings. Further research is necessary to test this hypothesis, including analytic epidemiological studies designed a priori to do so.
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Affiliation(s)
- Robert S Levine
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37205, USA.
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Datta GD, Kawachi I, Delpierre C, Lang T, Grosclaude P. Trends in Kaposi's sarcoma survival disparities in the United States: 1980 through 2004. Cancer Epidemiol Biomarkers Prev 2010; 19:2718-26. [PMID: 20861396 DOI: 10.1158/1055-9965.epi-10-0307] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Kaposi's sarcoma (KS) is the most common cancer diagnosed among people with HIV in the United States. Highly active antiretroviral therapy (HAART) is an essential treatment for KS, and recent reports document the emergence of racial disparities in KS incidence and HIV-related mortality in the post-HAART era (1996 to present). The aim of this study was to examine trends in KS survival by race from the beginning of the HIV epidemic through the introduction of HAART. METHODS Median cause-specific survival and adjusted hazard ratios for KS from 1980 to 2004 were calculated by race using Surveillance, Epidemiology, and End Results nine-area data. RESULTS Median survival among both black and white patients was relatively constant until 1995 (average median survival, 14 and 18 months, respectively). In 1996, white patients experienced an increase in median survival to 103 months. In subsequent years, the increase in median survival was so great that white patients did not reach 50% mortality (follow-up ending December 31, 2007). Survival among black patients increased gradually until its peak in 2001 when median survival had not been reached after 83 months of follow-up. However, subsequent relative decreases to 35 months occurred in 2002 and 2004. CONCLUSIONS The current analysis provides evidence that there have been substantial increases in KS survival among white patients in the HAART era. Black patients have also experienced some improvements but to an attenuated extent. IMPACT Careful attention should be paid to the continuing evolution of trends in KS survival and survival disparities.
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Affiliation(s)
- Geetanjali D Datta
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA.
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Pisu M, Wang D, Martin MY, Baltrus P, Levine RS. Presence of medical schools may contribute to reducing breast cancer mortality and disparities. J Health Care Poor Underserved 2010; 21:961-76. [PMID: 20693738 PMCID: PMC2946795 DOI: 10.1353/hpu.0.0346] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Understanding differences among counties more or less successful in addressing breast cancer (BC) mortality disparities is important. Medical resources may be more available in counties with BC mortality rates (BCMR) low and similar for White and Black women. Based on Black and White BCMR we classified selected counties in four types from failing (high BCMR for both groups of women) to successful (low BCMR for both). Medical resource data were from Area Resource Files. In multivariate analyses, number of physicians or hospitals, HMO penetration, and proportion of hospitals with mammography centers did not predict county type. The proportion of hospitals with medical schools predicted counties being with Black:White disparities vs. with reverse disparities (OR 0.96, CI 0.94-0.99), or being successful vs. failing (OR 1.03, CI 1.00-1.06) or vs. with disparities (OR 1.04, CI 1.01-1.07). Medical resources did not explain county type differences, but type of care available may be important.
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Affiliation(s)
- Maria Pisu
- Department of Medicine, Division of Preventive Medicine, University of Alabama, Birmingham, Birmingham, AL 35294-4410, USA.
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