Fife D, Mode C
AIDS Activities Coordinating Office, Philadelphia Department of Public Health, PA 19107.
J Acquir Immune Defic Syndr (1988). 1992;5(11):1105-10.
Since 1987, the annual increases of AIDS incidence among homosexual and bisexual men have slowed but the increases among other risk groups have continued unabated. Although indirect evidence suggests the incidence change is related to medical care for HIV disease delaying the onset of AIDS, other explanations are also possible. To examine the incidence change from a different perspective, we classified the residents of Philadelphia (PA, U.S.A.) with AIDS by the per capita income of their census tracts of residence. AIDS incidence increased steadily in the lowest income tercile, showed continuing but smaller increases after 1987 in the middle tercile, and was level after 1987 in the highest income tercile. The relationship between income and changes of incidence persisted after stratification on race or mode of infection with HIV. Income was associated with private medical insurance at the time of diagnosis of AIDS (59% privately insured in the highest income tercile, 24% in the lowest) and with median survival after a diagnosis of AIDS (467 days in the highest tercile of income, 359 days in the lowest). These observations are consistent with a medical treatment benefit that reaches the highest tercile of income and does not reach the lowest one.
自1987年以来，同性恋和双性恋男性中艾滋病发病率的年度增长有所放缓，但其他风险群体中的发病率仍持续上升且未减弱。虽然间接证据表明发病率的变化与针对艾滋病毒疾病的医疗护理导致艾滋病发病延迟有关，但也可能存在其他解释。为了从不同角度研究发病率的变化，我们根据居住普查区的人均收入对美国宾夕法尼亚州费城的艾滋病患者进行了分类。在收入最低的三分位数人群中，艾滋病发病率稳步上升；在收入中等的三分位数人群中，1987年后发病率持续上升但增幅较小；在收入最高的三分位数人群中，1987年后发病率保持平稳。在按种族或艾滋病毒感染方式进行分层后，收入与发病率变化之间的关系依然存在。收入与艾滋病诊断时的私人医疗保险相关（收入最高的三分位数人群中有59%拥有私人保险，收入最低的为24%），也与艾滋病诊断后的中位生存期相关（收入最高的三分位数人群为467天，收入最低的为359天）。这些观察结果与一种医疗治疗益处相符，即这种益处惠及收入最高的三分位数人群，而未惠及收入最低的人群。
