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Am J Public Health. 2010 Jun;100(6):1053-9. doi: 10.2105/AJPH.2009.170241. Epub 2010 Apr 19.

Examination of inequalities in HIV/AIDS mortality in the United States from a fundamental cause perspective.

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1
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, NY, USA.

Erratum in

  • Am J Public Health. 2011 Jan;101(1):5.

Abstract

OBJECTIVES:

We examined changes in socioeconomic status (SES) and Black to White inequalities in HIV/AIDS mortality in the United States before and after the introduction of highly active antiretroviral therapy (HAART).

METHODS:

Taking a fundamental cause perspective, we used negative binomial regression to analyze trends in county-level gender-, race-, and age-specific HIV/AIDS mortality rates among those aged 15 to 64 years during the period 1987-2005.

RESULTS:

Although HIV/AIDS mortality rates decreased once HAART became available, the declines were not uniformly distributed among population groups. The associations between SES and HIV/AIDS mortality and between race and HIV/AIDS mortality, although present in the pre-HAART period, were significantly greater in the peri- and post-HAART periods, with higher SES and White race associated with the greatest declines in mortality during the post-HAART period.

CONCLUSIONS:

Our findings support the fundamental cause hypothesis, as the introduction of a life-extending treatment exacerbated inequalities in HIV/AIDS mortality by SES and by race. In addition to a strong focus on factors that improve overall population health, more effective public health interventions and policies would facilitate an equitable distribution of health-enhancing innovations.

Comment in

PMID:
20403885
PMCID:
PMC2866621
DOI:
10.2105/AJPH.2009.170241
[Indexed for MEDLINE]
Free PMC Article
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