社会资本与艾滋病结果在地理上如何聚类，以及哪些社会背景机制预测了不同聚类之间的差异？
How Do Social Capital and HIV/AIDS Outcomes Geographically Cluster and Which Sociocontextual Mechanisms Predict Differences Across Clusters?
作者信息
Ransome Yusuf, Dean Lorraine T, Crawford Natalie D, Metzger David S, Blank Michael B, Nunn Amy S
机构信息
*Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA;†Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;‡Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA;§Department of Psychiatry, University of Pennsylvania Pearlman School of Medicine, Pennsylvania, PA; and‖Department of Behavioral and Social Sciences, Brown University School of Public Health, Rhode Island Public Health Institute, Providence, RI.
出版信息
J Acquir Immune Defic Syndr. 2017 Sep 1;76(1):13-22. doi: 10.1097/QAI.0000000000001463.
BACKGROUND
Place of residence has been associated with HIV transmission risks. Social capital, defined as features of social organization that improve efficiency of society by facilitating coordinated actions, often varies by neighborhood, and hypothesized to have protective effects on HIV care continuum outcomes. We examined whether the association between social capital and 2 HIV care continuum outcomes clustered geographically and whether sociocontextual mechanisms predict differences across clusters.
METHODS
Bivariate Local Moran's I evaluated geographical clustering in the association between social capital (participation in civic and social organizations, 2006, 2008, 2010) and [5-year (2007-2011) prevalence of late HIV diagnosis and linkage to HIV care] across Philadelphia, PA, census tracts (N = 378). Maps documented the clusters and multinomial regression assessed which sociocontextual mechanisms (eg, racial composition) predict differences across clusters.
RESULTS
We identified 4 significant clusters (high social capital-high HIV/AIDS, low social capital-low HIV/AIDS, low social capital-high HIV/AIDS, and high social capital-low HIV/AIDS). Moran's I between social capital and late HIV diagnosis was (I = 0.19, z = 9.54, P < 0.001) and linkage to HIV care (I = 0.06, z = 3.274, P = 0.002). In multivariable analysis, median household income predicted differences across clusters, particularly where social capital was lowest and HIV burden the highest, compared with clusters with high social capital and lowest HIV burden.
DISCUSSION
The association between social participation and HIV care continuum outcomes cluster geographically in Philadelphia, PA. HIV prevention interventions should account for this phenomenon. Reducing geographic disparities will require interventions tailored to each continuum step and that address socioeconomic factors such as neighborhood median income.
背景
居住地点与艾滋病毒传播风险相关。社会资本被定义为社会组织的特征，通过促进协调行动提高社会效率，其往往因社区而异，并被假设对艾滋病毒护理连续结果具有保护作用。我们研究了社会资本与两个艾滋病毒护理连续结果之间的关联是否在地理上聚集，以及社会背景机制是否能预测不同集群之间的差异。
方法
双变量局部莫兰指数（Bivariate Local Moran's I）评估了宾夕法尼亚州费城普查区（N = 378）中社会资本（2006年、2008年、2010年参与公民和社会组织情况）与[艾滋病毒晚期诊断的5年（2007 - 2011年）患病率及与艾滋病毒护理的联系]之间关联的地理聚集情况。地图记录了这些集群，多项回归分析评估了哪些社会背景机制（如种族构成）能预测不同集群之间的差异。
结果
我们识别出4个显著集群（高社会资本 - 高艾滋病毒/艾滋病、低社会资本 - 低艾滋病毒/艾滋病、低社会资本 - 高艾滋病毒/艾滋病和高社会资本 - 低艾滋病毒/艾滋病）。社会资本与艾滋病毒晚期诊断之间的莫兰指数为（I = 0.19，z = 9.54，P < 0.001），与艾滋病毒护理联系之间的莫兰指数为（I = 0.06，z = 3.274，P = 0.002）。在多变量分析中，家庭收入中位数预测了不同集群之间的差异，特别是与高社会资本和低艾滋病毒负担的集群相比，在社会资本最低且艾滋病毒负担最高的地方。
讨论
在宾夕法尼亚州费城，社会参与与艾滋病毒护理连续结果之间的关联在地理上聚集。艾滋病毒预防干预措施应考虑到这一现象。减少地理差异将需要针对每个连续阶段量身定制干预措施，并解决诸如社区收入中位数等社会经济因素。
Zotero 插件