Influence of residential segregation on survival after AIDS diagnosis among non-Hispanic blacks

Abstract

PurposeNon-Hispanic blacks (NHBs) are disproportionately affected by the AIDS epidemic. With the advent of highly active antiretroviral therapy (HAART), survival after AIDS diagnosis has increased dramatically, yet survival among NHBs is shorter compared with non-Hispanic whites. Racial residential segregation may be an important factor influencing observed racial disparities in survival. MethodsWe linked data on 30,813 NHBs from the Florida Department of Health HIV/AIDS Reporting system (1993–2004) with death records and applied segregation indices and poverty levels to the data. Weighted Cox models were used to examine the association between segregation measured on five dimensions and survival, controlling for demographic factors, clinical factors, and area-level poverty. Analyses were stratified by pre-HAART (1993–1995), early HAART (1996–1998), and late-HAART (1999–2004) eras. ResultsIn the late-HAART era, adjusting for area-level poverty, segregation remained a significant predictor of survival on two dimensions: Concentration (hazard ratio, 1.32; 95% confidence interval, 1.13–1.56) and centralization (hazard ratio, 1.44; 95% confidence interval, 1.12–1.84). Area-level poverty was an independent predictor of survival. ConclusionsThese findings suggest that certain dimensions of segregation and poverty are associated with survival after AIDS diagnosis.