Individual and community-level effects in the socioeconomic inequalities of AIDS-related mortality in an urban area of southern Europe.

Full Abstract

OBJECTIVE:
To study socioeconomic inequalities in AIDS mortality in Barcelona, Spain, during the periods 1991-6 (before highly active antiretroviral therapy (HAART)) and 1997-2001 (post-HAART) taking into account individual as well as community effects of socioeconomic level.

DESIGN:
Cross-sectional design.

SETTING:
Barcelona, Spain.

PARTICIPANTS:
All residents aged > or =20 years. All AIDS-related deaths occurring between 1991 and 2001 were studied. The individual variables analysed were age, sex, educational level, neighbourhood of residence and HIV transmission group. Male unemployment was used as the community-level indicator of neighbourhood deprivation. Multilevel Poisson regression models were fitted to estimate the relationship between AIDS mortality and the individual- and community-level variables.

RESULTS:
At the individual level, AIDS mortality relative risks (RR) were higher among intravenous drug users (IDUs) with lower educational level in both periods. For the younger population, the RR of AIDS-related mortality associated with having little education compared with having a primary education or more was 4.7 (95% CI 3.6 to 6.1) in men and 5.2 (95%CI 3.6 to 7.7) in women in the pre-HAART period, and 4.7 (95% CI 2.7 to 8.1) in men and 4.5 (95% CI 1.4 to 14.1) in women in the post-HAART period. At the community level, an area effect in AIDS mortality was found, which was more important in neighbourhoods having high deprivation in both periods, although the effect was most important in the post-HAART period.

CONCLUSIONS:
This study has shown inequalities in AIDS mortality in terms of both individual variables and a community-level variable in the pre-HAART as well as in the post-HAART period. These socioeconomic inequalities of AIDS mortality must be considered when prevention and treatment strategies are implemented.

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Author information

Author/s: Marí-Dell'Olmo, Marc (M); Rodríguez-Sanz, Maica (M); Garcia-Olalla, Patrícia (P); Pasarín, M Isabel (MI); Brugal, M Teresa (MT); Caylà, Joan A (JA); Borrell, Carme (C);

Affiliation: Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain.

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Journal of epidemiology and community health (J Epidemiol Community Health), published in England. (Language: eng)

Reference: 2007-Mar; vol 61 (issue 3) : pp 232-40

Dates: Created 2007/02/27; Completed 2007/05/01;

PMID: 17325402, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Acquired Immunodeficiency Syndrome - drug therapy; mortality; transmission
Adult
Antiretroviral Therapy, Highly Active
Cross-Sectional Studies
Educational Status
Europe - epidemiology
Female
Humans

Male
Middle Aged
Poverty Areas
Risk Factors
Socioeconomic Factors
Spain - epidemiology
Substance Abuse, Intravenous - complications
Urban Health - statistics & numerical data

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