Katz M H, Hsu L, Lingo M, Woelffer G, Schwarcz S K
San Francisco Department of Public Health, CA, USA.
Am J Epidemiol. 1998 Aug 1;148(3):282-91. doi: 10.1093/oxfordjournals.aje.a009637.
Prior studies of the association between socioeconomic status and length of survival among persons infected with the human immunodeficiency virus (HIV) have produced conflicting results. To investigate this issue further, the authors examined data on 18,167 San Francisco, California, residents aged 13 years or older who were diagnosed with acquired immunodeficiency syndrome (AIDS) between January 1, 1985, and December 31, 1995. Three validated US census-based measures of socioeconomic status were used: poverty, predominantly working class neighborhood, and low educational level. Median length of survival was found to be similar for persons living in neighborhoods characterized by poverty (22 months) and those in higher income neighborhoods (23 months), for persons living in predominantly working class neighborhoods (22 months) and those in predominantly professional/managerial neighborhoods (23 months), and for persons living in neighborhoods characterized by low educational level (23 months) and those in neighborhoods characterized by higher educational level (23 months). After adjustment for sex, age, ethnicity, AIDS risk group, site of AIDS diagnosis, time period of AIDS diagnosis, and AIDS-indicator illness, no association was found between survival and living in a neighborhood characterized by poverty (relative hazard (RH)=1.03, 95% confidence interval (CI) 0.97-1.08), between survival and working class occupations (RH=1.03, 95% CI 0.98-1.08), or between survival and low educational level (RH=0.96, 95% CI 0.90-1.01). The lack of an association between socioeconomic status and length of survival with AIDS may be due to the high mortality from AIDS in the era prior to highly effective antiretroviral therapy or to similar levels of access to care in San Francisco.
先前关于社会经济地位与感染人类免疫缺陷病毒（HIV）者生存时长之间关联的研究结果相互矛盾。为进一步探究此问题，作者分析了1985年1月1日至1995年12月31日期间，加利福尼亚州旧金山18167名年龄在13岁及以上、被诊断患有获得性免疫缺陷综合征（AIDS）的居民的数据。采用了三种基于美国人口普查且经验证有效的社会经济地位衡量指标：贫困、主要为工人阶级社区以及低教育水平。研究发现，生活在贫困社区的人群（生存时长中位数为22个月）与高收入社区人群（23个月）、主要生活在工人阶级社区的人群（22个月）与主要生活在专业/管理阶层社区的人群（23个月）、生活在低教育水平社区的人群（23个月）与高教育水平社区人群（23个月）的生存时长中位数相似。在对性别、年龄、种族、艾滋病风险组、艾滋病诊断部位、艾滋病诊断时间段以及艾滋病指示性疾病进行调整后，未发现生存与生活在贫困社区之间存在关联（相对危险度（RH）=1.03，95%置信区间（CI）0.97 - 1.08），生存与工人阶级职业之间不存在关联（RH = 1.03，95% CI 0.98 - 1.08），生存与低教育水平之间也不存在关联（RH = 0.96，95% CI 0.90 - 1.01）。社会经济地位与艾滋病生存时长之间缺乏关联，可能是由于在高效抗逆转录病毒疗法出现之前的时代，艾滋病死亡率高，或者是由于旧金山的医疗服务可及水平相近。
