Health Outcomes and Pharmacy Practice Division, the University of Texas at Austin College of Pharmacy, Austin, TX, USA.
J Racial Ethn Health Disparities. 2018 Oct;5(5):1023-1032. doi: 10.1007/s40615-017-0450-1. Epub 2017 Dec 21.
National studies show that Blacks with HIV have higher mortality rates compared to Whites. This study aimed to identify trends in Black racial disparities among Texas residents living with HIV. Using HIV surveillance data from the Texas Department of State Health Services, a cohort of HIV-diagnosed patients (N = 70,996) were identified and grouped according to year of diagnosis, 1996-1997 (T1), 1998-2006 (T2), 2007-2010 (T3), and 2011-2013 (T4). Survival analysis was used to examine racial differences in death rate (analysis 1) and clinical progression to AIDS (analysis 2) for each subcohort, using Blacks as the reference group. In analysis 1, Whites (hazard ratio, HR = 0.80, 95% confidence interval, CI = 0.74-0.87, p < 0.001; HR = 0.82, 95% CI = 0.78-0.87, p < 0.001; respectively) and Hispanics (HR = 0.72, 95% CI = 0.66-0.79, p < 0.001; HR = 0.77, 95% CI = 0.74-0.81, p < 0.001, respectively) had lower death rates in T1 and T2. This remained significant after adjusting for covariates. In T3, death rate was higher for Hispanics after adjustment (HR = 1.13, 95% CI = 1.00-1.28, p < 0.05). In T4, death rate was higher for Whites (HR = 1.66, 95% CI = 1.30-2.13, p < 0.001) and Hispanics (HR = 1.66, 95% CI = 1.34-2.06, p < 0.001). These relationships became non-significant after adjusting for covariates. In analysis 2, the rate of clinical progression to AIDS was higher for Hispanics in all subcohorts. The significance remained after adjusting for covariates. The rate of clinical progression to AIDS was lower for Whites after adjustments in T2 and T3. Additional studies are needed to understand factors that may explain this unexpected finding of improved survival for Blacks over time. Such studies may inform decision-making in HIV care to reduce Black HIV disparities.
国家研究表明，与白人相比，感染艾滋病毒的黑人死亡率更高。本研究旨在确定德克萨斯州感染艾滋病毒的居民中黑人种族差异的趋势。使用德克萨斯州州立卫生服务部的艾滋病毒监测数据，确定了一组艾滋病毒确诊患者（N=70996），并根据诊断年份（1996-1997 年（T1）、1998-2006 年（T2）、2007-2010 年（T3）和 2011-2013 年（T4））进行分组。使用生存分析检查每个亚组中死亡率（分析 1）和临床进展到艾滋病（分析 2）的种族差异，以黑人作为参考组。在分析 1 中，白人（危险比，HR=0.80，95%置信区间，CI=0.74-0.87，p<0.001；HR=0.82，95%CI=0.78-0.87，p<0.001）和西班牙裔（HR=0.72，95%CI=0.66-0.79，p<0.001；HR=0.77，95%CI=0.74-0.81，p<0.001，分别）在 T1 和 T2 中的死亡率较低。在调整协变量后，这仍然具有统计学意义。在 T3 中，西班牙裔的死亡率在调整后较高（HR=1.13，95%CI=1.00-1.28，p<0.05）。在 T4 中，白人（HR=1.66，95%CI=1.30-2.13，p<0.001）和西班牙裔（HR=1.66，95%CI=1.34-2.06，p<0.001）的死亡率较高。在调整协变量后，这些关系变得不显著。在分析 2 中，所有亚组中西班牙裔的临床进展到艾滋病的比率都较高。在调整协变量后，这仍然具有统计学意义。在 T2 和 T3 调整后，白人的临床进展到艾滋病的比率较低。需要进一步的研究来了解可能解释黑人随着时间的推移生存状况改善的因素。这些研究可能为艾滋病毒护理决策提供信息，以减少黑人和西班牙裔之间的艾滋病毒差异。
