Rural AIDS Diagnoses in Florida: Changing Demographics and Factors Associated With Survival

Abstract

Purpose To compare demographic characteristics and predictors of survival of rural residents diagnosed with acquired immunodeficiency syndrome (AIDS) with those of urban residents. Methods Florida surveillance data for people diagnosed with AIDS during 1993–2007 were merged with 2000 Census data using ZIP code tabulation areas (ZCTA). Rural status was classified based on the ZCTA’s rural-urban commuting area classification. Survival rates were compared between rural and urban areas using survival curves and Cox proportional hazards models controlling for demographic, clinical, and area-level socioeconomic and health care access factors. Findings Of the 73,590 people diagnosed with AIDS, 1,991 (2.7%) resided in rural areas. People in the most recent rural cohorts were more likely than those in earlier cohorts to be female, non-Hispanic black, older, and have a reported transmission mode of heterosexual sex. There were no statistically significant differences in the 3-, 5-, or 10-year survival rates between rural and urban residents. Older age at the time of diagnosis, diagnosis during the 1993–1995 period, other/unknown transmission mode, and lower CD4 count/percent categories were associated with lower survival in both rural and urban areas. In urban areas only, being non-Hispanic black or Hispanic, being US born, more poverty, less community social support, and lower physician density were also associated with lower survival. Conclusions In rural Florida, the demographic characteristics of people diagnosed with AIDS have been changing, which may necessitate modifications in the delivery of AIDS-related services. Rural residents diagnosed with AIDS did not have a significant survival disadvantage relative to urban residents.

Individual and neighborhood predictors of mortality among HIV-positive Latinos with history of injection drug use, Florida, 2000–2011

“…This effect was observed despite the relatively small number of rural residents, and the effect decreased after adjusting for individual-level and neighborhood-level factors. A previous study of HIV-positive individuals in Florida indicated no survival disparity between rural and urban residents (Trepka et al, 2013a), consistent with our findings for Latinos without history of IDU. Our finding for Latinos with history of IDU might have differed because the previous study examined individuals with AIDS of all races/ethnicities across all HIV-risk groups.…”

Late HIV Diagnosis: Differences by Rural/Urban Residence, Florida, 2007–2011

“…The rural resident diagnosis disadvantage was somewhat unexpected, given the results of an earlier study in Florida finding no survival disadvantage between people in rural and urban areas diagnosed with AIDS between 1993-2007. 36 However, that study used an earlier time period and examined survival from the time of AIDS and not the time of HIV diagnosis. Furthermore, survival is affected by care and treatment in addition to early diagnosis.…”

Black–White Latino Racial Disparities in HIV Survival, Florida, 2000–2011

“…The finding that Black Latinos with HIV are at increased mortality risk compared with White Latinos with HIV is important. The disparity not only remains after controlling for individual- and neighborhood-level factors, but it also appears to be at least as great as the racial disparity in mortality between Black and White non-Latinos with HIV [ 3 , 4 , 5 ]. Two studies, including one in Florida, found that survival disparities between non-Latino Blacks and non-Latino Whites with AIDS disappeared after controlling for neighborhood poverty [ 3 , 5 ].…”

“…In 2011, the mortality rate for non-Latino Blacks with HIV was 24.2 per 1000 persons living with HIV, compared with 20.6 for non-Latino Whites [ 1 ]. Additionally, non-Latino Black males and females experience shorter life expectancy [ 2 ] and increased risk of death [ 3 , 4 , 5 ] after HIV diagnosis compared with non-Latino Whites.…”