TY - JOUR
T1 - AIDS mortality before and after the introduction of highly active antiretroviral therapy
T2 - Does it vary with socioeconomic group in a country with a National Health System?
AU - Borrell, Carme
AU - Rodríguez-Sanz, Maica
AU - Pasarín, M. Isabel
AU - Brugal, M. Teresa
AU - García-De-Olalla, Patricia
AU - Marí-Dell'Olmo, Marc
AU - Caylà, Joan
N1 - Funding Information:
This study was made possible by financial support from FIPSE (grant number 2425/01) and FISS C03/09, G03/05 (Cooperative Investigation Networks).
PY - 2006/12
Y1 - 2006/12
N2 - Background: The aim of this study is to determine whether socioeconomic AIDS mortality inequalities before and after the introduction of highly active antiretroviral therapy (HAART) have increased or decreased in a Spanish city where HAART is free. Methods: The study used a trend design, including all Barcelona residents older than 19 years of age. All AIDS deaths, which occurred among these residents between 1991 and 2001 were included. The variables studied were age, sex, socioeconomic (SES) group and HIV transmission group. AIDS age-standardized mortality rates for each year were estimated. Poisson regression models were fitted to obtain the relative risk (RR) of AIDS death for each socioeconomic group with respect to the reference group. Results: AIDS mortality increased up until 1995 and subsequently decreased due to the introduction of HAART. The increase in AIDS mortality was greater in the lowest SES group, which had higher rates and a RR of dying larger than that of the highest SES group, fact that remained fairly stable over the whole period. A similar pattern was observed in intravenous drug users. In the homosexual transmission group, rates for the lowest SES group were higher for the whole period and increased until 1996, while rates for the other SES groups were lower and decreased over the entire period. Conclusions: The fact that inequalities in AIDS mortality by SES group remained fairly stable for the whole period suggests that perhaps access to HAART, or adherence, is lower than desirable, in people of lower SES groups. These results ought to be taken into account when implementing treatment and prevention strategies.
AB - Background: The aim of this study is to determine whether socioeconomic AIDS mortality inequalities before and after the introduction of highly active antiretroviral therapy (HAART) have increased or decreased in a Spanish city where HAART is free. Methods: The study used a trend design, including all Barcelona residents older than 19 years of age. All AIDS deaths, which occurred among these residents between 1991 and 2001 were included. The variables studied were age, sex, socioeconomic (SES) group and HIV transmission group. AIDS age-standardized mortality rates for each year were estimated. Poisson regression models were fitted to obtain the relative risk (RR) of AIDS death for each socioeconomic group with respect to the reference group. Results: AIDS mortality increased up until 1995 and subsequently decreased due to the introduction of HAART. The increase in AIDS mortality was greater in the lowest SES group, which had higher rates and a RR of dying larger than that of the highest SES group, fact that remained fairly stable over the whole period. A similar pattern was observed in intravenous drug users. In the homosexual transmission group, rates for the lowest SES group were higher for the whole period and increased until 1996, while rates for the other SES groups were lower and decreased over the entire period. Conclusions: The fact that inequalities in AIDS mortality by SES group remained fairly stable for the whole period suggests that perhaps access to HAART, or adherence, is lower than desirable, in people of lower SES groups. These results ought to be taken into account when implementing treatment and prevention strategies.
KW - AIDS mortality
KW - HAART therapy
KW - Socioeconomic inequalities
KW - Southern Europe
KW - Trends
KW - Urban area
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U2 - 10.1093/eurpub/ckl062
DO - 10.1093/eurpub/ckl062
M3 - Article
C2 - 16698886
AN - SCOPUS:33845417644
SN - 1101-1262
VL - 16
SP - 601
EP - 608
JO - European Journal of Public Health
JF - European Journal of Public Health
IS - 6
ER -