Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, NY, USA.
Am J Public Health. 2010 Jun;100(6):1053-9. doi: 10.2105/AJPH.2009.170241. Epub 2010 Apr 19.
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).
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.
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.
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.
本研究旨在探讨高效抗逆转录病毒疗法（HAART）问世前后，美国社会经济地位（SES）变化和黑人群体与白人群体在艾滋病相关死亡率方面不平等现象的变化趋势。
本研究从根本原因的角度出发，采用负二项回归分析方法，分析了 1987 年至 2005 年期间年龄在 15 至 64 岁之间的人群中，按性别、种族和年龄分层的县一级艾滋病毒/艾滋病死亡率的变化趋势。
尽管 HAART 问世后艾滋病相关死亡率有所下降，但下降趋势在不同人群中并不均衡。在 HAART 问世之前，SES 与艾滋病死亡率之间以及种族与艾滋病死亡率之间存在关联，而在 HAART 问世前后，这些关联更加显著，SES 较高和白人群体与艾滋病死亡率下降幅度最大。
本研究结果支持根本原因假说，即延长生命的治疗方法的引入加剧了 SES 和种族因素导致的艾滋病死亡率的不平等现象。除了高度关注能够改善整体人口健康的因素外，更有效的公共卫生干预措施和政策将有助于促进健康促进创新的公平分配。
