Individual and community-level effects in the socioeconomic inequalities of AIDS-related mortality in an urban area of southern Europe
- 1 March 2007
- journal article
- Published by BMJ in Journal of Epidemiology and Community Health
- Vol. 61 (3), 232-240
- https://doi.org/10.1136/jech.2006.048017
Abstract
Objective: To study socioeconomic inequalities in AIDS mortality in Barcelona, Spain, during the periods 1991–6 (before highly active antiretroviral therapy (HAART)) and 1997–2001 (post-HAART) taking into account individual as well as community effects of socioeconomic level. Design: Cross-sectional design. Setting: Barcelona, Spain. Participants: All residents aged ⩾20 years. All AIDS-related deaths occurring between 1991 and 2001 were studied. The individual variables analysed were age, sex, educational level, neighbourhood of residence and HIV transmission group. Male unemployment was used as the community-level indicator of neighbourhood deprivation. Multilevel Poisson regression models were fitted to estimate the relationship between AIDS mortality and the individual- and community-level variables. Results: At the individual level, AIDS mortality relative risks (RR) were higher among intravenous drug users (IDUs) with lower educational level in both periods. For the younger population, the RR of AIDS-related mortality associated with having little education compared with having a primary education or more was 4.7 (95% CI 3.6 to 6.1) in men and 5.2 (95%CI 3.6 to 7.7) in women in the pre-HAART period, and 4.7 (95% CI 2.7 to 8.1) in men and 4.5 (95% CI 1.4 to 14.1) in women in the post-HAART period. At the community level, an area effect in AIDS mortality was found, which was more important in neighbourhoods having high deprivation in both periods, although the effect was most important in the post-HAART period. Conclusions: This study has shown inequalities in AIDS mortality in terms of both individual variables and a community-level variable in the pre-HAART as well as in the post-HAART period. These socioeconomic inequalities of AIDS mortality must be considered when prevention and treatment strategies are implemented.Keywords
This publication has 35 references indexed in Scilit:
- AIDS mortality before and after the introduction of highly active antiretroviral therapy: does it vary with socioeconomic group in a country with a National Health System?European Journal of Public Health, 2006
- This Place Is Killing Me: A Comparison of Counties Where the Incidence Rates of AIDS Increased the Most and the LeastThe Journal of Infectious Diseases, 2005
- Appropriate Assessment of Neighborhood Effects on Individual Health: Integrating Random and Fixed Effects in Multilevel Logistic RegressionAmerican Journal of Epidemiology, 2005
- The Social Epidemiology of Human Immunodeficiency Virus/Acquired Immunodeficiency SyndromeEpidemiologic Reviews, 2004
- Buscando una aguja en un pajar: las técnicas de conexión de registros en los sistemas de información sanitariaMedicina Clinica, 2004
- Prevalence and Correlates of Untreated Human Immunodeficiency Virus Type 1 Infection among Persons Who Have Died in the Era of Modern Antiretroviral TherapyThe Journal of Infectious Diseases, 2003
- Socioeconomic Status and Survival of Persons with AIDS before and after the Introduction of Highly Active Antiretroviral TherapyEpidemiology, 2000
- Socioeconomic Influences on the Transmission of Human Immunodeficiency Virus Infection: The Hidden RiskArchives of Family Medicine, 1998
- Widening social inequalities in mortality: the case of Barcelona, a southern European city.Journal of Epidemiology and Community Health, 1997
- Will AIDS be contained within U.S. minority urban populations?Social Science & Medicine (1982), 1994