HIV-related mortality decreased markedly since the mid-1990s across all demographic groups except among non-Hispanic blacks with low levels of educational attainment, according to a report published online Oct. 8 in Archives of Internal Medicine.
The inevitable result of these temporal trends is a widening gap between whites and nonwhites in deaths from HIV.
Courtesy Dr. Tom Folks, NIAID/National Institutes of Health
HIV-Infected T Cells
"These findings suggest the need for focused interventions and resources to facilitate the identification of high-risk individuals, as well as entry and retention into care for these most vulnerable groups affected by the HIV epidemic in the United States," said Edgar P. Simard, Ph.D., of the American Cancer Society’s Surveillance Research Program, and his associates.
HIV has become a more predominant cause of death among blacks at the same time that its prominence as a cause of death among whites has been on the decline. It was the ninth-leading cause of death among blacks in the most recent year for which data are available, but only the 24th-leading cause of death among whites, the authors noted.
"We posit that black men and minority women, in particular those with low socioeconomic status, may be exceptionally vulnerable to HIV deaths owing to a combined lack of knowledge of HIV prevention, lack of knowledge of their own HIV status, lack of access to the health care system, social stigma, and marginalization." --Dr. Simard and associates.
Dr. Simard and his colleagues examined trends in HIV mortality using data recorded on death certificates and filed in the National Vital Statistics System, which is administered by the National Center for Health Statistics. In recent years, death certificates have included patients’ educational attainment, which these investigators used as a proxy for the subjects’ socioeconomic status. The lowest level of educational attainment was defined as less than or equal to 12 years of education as reported by next of kin.
The researchers also categorized the data according to the subjects’ sex and race/ethnicity. They assessed 91,307 HIV-related deaths among adults aged 25-64 years across 26 states, focusing on comparing the data from 1993-1995 against that from 2005-2007.
Overall, HIV mortality declined over time for most men and women of all ethnicities and educational levels. The main exceptions to the across-the-board sharp decline in HIV-related mortality were found among non-Hispanic black women of low educational attainment, in whom HIV mortality remained markedly high, and Hispanic women with 13 to 15 years of education.
In addition, the reductions in mortality were much greater among whites than among nonwhites. Declines in mortality also generally were much greater among people with high educational attainment than among those with lower educational attainment. Both trends caused a widening in the already large gap between these groups.
For example, among non-Hispanic black men with the highest educational attainment, HIV mortality decreased from 117.89 to 15.35 per 100,000, a dramatic reduction. But this rate of 15.35 is still more than three times higher than the 5.04 per 100,000 rate in non-Hispanic white men with the highest educational attainment.
Although this study was not designed to find the reasons underlying these disparities, "We posit that black men and minority women, in particular those with low socioeconomic status, may be exceptionally vulnerable to HIV deaths owing to a combined lack of knowledge of HIV prevention, lack of knowledge of their own HIV status, lack of access to the health care system, social stigma, and marginalization," Dr. Simard and his associates said (Arch. Intern. Med. 2012 Oct. 8 [doi:10.1001/archinternmed.2012.4508]).
"Our findings suggest the importance of considering individuals not only on the basis of race/ethnicity but also by socioeconomic status for the purposes of allocating resources for HIV prevention and treatment," they added.
This study was funded by the American Cancer Society. No financial conflicts of interest were reported.