Truman Benedict I, Moonesinghe Ramal, Brown Yolanda T, Chang Man-Huei, Mermin Jonathan H, Dean Hazel D
1242 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
1242 Office of Minority Health and Health Equity, Office of the Deputy Director for Public Health Service and Implementation Science, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Public Health Rep. 2020 Jul/Aug;135(1_suppl):149S-157S. doi: 10.1177/0033354920912716.
Federal funds have been spent to reduce the disproportionate effects of HIV/AIDS on racial/ethnic minority groups in the United States. We investigated the association between federal domestic HIV funding and age-adjusted HIV death rates by race/ethnicity in the United States during 1999-2017.
We analyzed HIV funding data from the Kaiser Family Foundation by federal fiscal year (FFY) and US age-adjusted death rates (AADRs) by race/ethnicity (Hispanic, non-Hispanic white, non-Hispanic black, and Asian/Pacific Islander and American Indian/Alaska Native [API+AI/AN]) from Centers for Disease Control and Prevention WONDER detailed mortality files. We fit joinpoint regression models to estimate the annual percentage change (APC), average APC, and changes in AADRs per billion US dollars in HIV funding, with 95% confidence intervals (CIs). For 19 data points, the number of joinpoints ranged from 0 to 4 on the basis of rules set by the program or by the user. A Monte Carlo permutation test indicated significant ( < .05) changes at joinpoints, and 2-sided tests indicated significant APCs in AADRs.
Domestic HIV funding increased from $10.7 billion in FFY 1999 to $26.3 billion in FFY 2017, but AADRs decreased at different rates for each racial/ethnic group. The average rate of change in AADR per US billion dollars was -9.4% (95% CI, -10.9% to -7.8%) for Hispanic residents, -7.8% (95% CI, -9.0% to -6.6%) for non-Hispanic black residents, -6.7% (95% CI, -9.3% to -4.0%) for non-Hispanic white residents, and -5.2% (95% CI, -7.8% to -2.5%) for non-Hispanic API+AI/AN residents.
Increased domestic HIV funding was associated with faster decreases in age-adjusted HIV death rates for Hispanic and non-Hispanic black residents than for residents in other racial/ethnic groups. Increasing US HIV funding could be associated with decreasing future racial/ethnic disparities in the rate of HIV-related deaths.
联邦资金已用于减少美国艾滋病毒/艾滋病对种族/族裔少数群体的不均衡影响。我们调查了1999 - 2017年期间美国联邦国内艾滋病毒资金与按种族/族裔调整年龄后的艾滋病毒死亡率之间的关联。
我们分析了凯撒家庭基金会按联邦财政年度（FFY）统计的艾滋病毒资金数据，以及美国疾病控制与预防中心“奇迹”详细死亡率文件中按种族/族裔（西班牙裔、非西班牙裔白人、非西班牙裔黑人以及亚裔/太平洋岛民和美洲印第安人/阿拉斯加原住民[API + AI/AN]）调整年龄后的死亡率（AADR）。我们拟合连接点回归模型，以估计艾滋病毒资金每十亿美元的年度百分比变化（APC）、平均APC以及AADR的变化，并给出95%置信区间（CI）。对于19个数据点，连接点数量根据程序或用户设定的规则在0到4之间。蒙特卡罗排列检验表明连接点处有显著（<0.05）变化，双侧检验表明AADR中有显著的APC。
国内艾滋病毒资金从1999财年的107亿美元增加到2017财年的263亿美元，但每个种族/族裔群体的AADR以不同速率下降。每十亿美元的AADR平均变化率，西班牙裔居民为 - 9.4%（95%CI， - 10.9%至 - 7.8%），非西班牙裔黑人居民为 - 7.8%（95%CI， - 9.0%至 - 6.6%），非西班牙裔白人居民为 - 6.7%（95%CI， - 9.3%至 - 4.0%），非西班牙裔API + AI/AN居民为 - 5.2%（95%CI， - 7.8%至 - 2.5%）。
国内艾滋病毒资金增加与西班牙裔和非西班牙裔黑人居民年龄调整后的艾滋病毒死亡率下降速度快于其他种族/族裔群体的居民有关。增加美国艾滋病毒资金可能与未来艾滋病毒相关死亡率的种族/族裔差距缩小有关。
