Major reduction in AIDS-mortality inequalities after HAART: The importance of absolute differences in evaluating interventions
This study estimates the magnitude of inequalities in AIDS mortality in the period when highly active antiretroviral therapy (HAART) was introduced and after its widespread dissemination in the Region of Madrid, Spain. Two population cohorts were constructed by linking records from 1996 and 2001 pop...
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| Veröffentlicht in: | Social science & medicine (1982) 2009-02, Vol.68 (3), p.419-426 |
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| container_title | Social science & medicine (1982) |
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| creator | Regidor, Enrique Sánchez, Elisabeth de la Fuente, Luis Luquero, Francisco J. de Mateo, Salvador Domínguez, Vicente |
| description | This study estimates the magnitude of inequalities in AIDS mortality in the period when highly active antiretroviral therapy (HAART) was introduced and after its widespread dissemination in the Region of Madrid, Spain. Two population cohorts were constructed by linking records from 1996 and 2001 population censuses with mortality registry records after initial and full implementation of HAART, respectively. Absolute and relative differences in AIDS mortality in people aged 20–49 years were estimated in each population cohort according to neighbourhood and individual socioeconomic position. The absolute difference in mortality between neighbourhoods with highest and lowest socioeconomic position (unemployment rate, per capita income) declined from about 30/100,000 person-years in the 1996 population cohort to 8/100,000 person-years in the 2001 population cohort. The absolute difference in mortality between individuals with the highest and lowest socioeconomic position fell from about 60/100,000 person-years in the first cohort to about 20/100,000 in the second. Relative differences in mortality by neighbourhood socioeconomic position and by individual education level also decreased in the 2001 cohort with respect to the 1996 cohort. Although relative differences by individual occupation increased, there was no evidence of a significant change. These findings show major reduction in absolute socioeconomic differences in AIDS mortality after HAART and indicate that the use of relative differences alone may be inadequate to fully evaluate the results of health interventions. |
| doi_str_mv | 10.1016/j.socscimed.2008.10.039 |
| format | Article |
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Two population cohorts were constructed by linking records from 1996 and 2001 population censuses with mortality registry records after initial and full implementation of HAART, respectively. Absolute and relative differences in AIDS mortality in people aged 20–49 years were estimated in each population cohort according to neighbourhood and individual socioeconomic position. The absolute difference in mortality between neighbourhoods with highest and lowest socioeconomic position (unemployment rate, per capita income) declined from about 30/100,000 person-years in the 1996 population cohort to 8/100,000 person-years in the 2001 population cohort. The absolute difference in mortality between individuals with the highest and lowest socioeconomic position fell from about 60/100,000 person-years in the first cohort to about 20/100,000 in the second. Relative differences in mortality by neighbourhood socioeconomic position and by individual education level also decreased in the 2001 cohort with respect to the 1996 cohort. Although relative differences by individual occupation increased, there was no evidence of a significant change. These findings show major reduction in absolute socioeconomic differences in AIDS mortality after HAART and indicate that the use of relative differences alone may be inadequate to fully evaluate the results of health interventions.</description><identifier>ISSN: 0277-9536</identifier><identifier>EISSN: 1873-5347</identifier><identifier>DOI: 10.1016/j.socscimed.2008.10.039</identifier><identifier>PMID: 19056156</identifier><identifier>CODEN: SSMDEP</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Absolute differences ; Acquired Immune Deficiency Syndrome ; Acquired Immunodeficiency Syndrome - drug therapy ; Acquired Immunodeficiency Syndrome - mortality ; Adult ; AIDS ; Antiretroviral drugs ; Antiretroviral Therapy, Highly Active - utilization ; Biological and medical sciences ; Cohort Studies ; Death ; Differences ; Drug therapy ; Epidemiology ; Female ; General aspects ; HAART ; HAART AIDS Measures of inequities in health Relative differences Absolute differences Spain Neighbourhoods ; Health ; Health inequality ; Health Status Disparities ; Human viral diseases ; Humans ; Inequality ; Infectious diseases ; Intervention ; Male ; Measurement ; Measures of inequities in health ; Medical Record Linkage ; Medical sciences ; Medical treatment ; Middle Aged ; Miscellaneous ; Mortality ; Neighborhoods ; Neighbourhoods ; Poverty ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Registries ; Relative differences ; Residence Characteristics - classification ; Social Class ; Socioeconomic status ; Spain ; Spain - epidemiology ; Survival Analysis ; Urban Health - classification ; Urban Health - statistics & numerical data ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; Vulnerable Populations - statistics & numerical data ; Young Adult</subject><ispartof>Social science & medicine (1982), 2009-02, Vol.68 (3), p.419-426</ispartof><rights>2008 Elsevier Ltd</rights><rights>2009 INIST-CNRS</rights><rights>Copyright Pergamon Press Inc. 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Two population cohorts were constructed by linking records from 1996 and 2001 population censuses with mortality registry records after initial and full implementation of HAART, respectively. Absolute and relative differences in AIDS mortality in people aged 20–49 years were estimated in each population cohort according to neighbourhood and individual socioeconomic position. The absolute difference in mortality between neighbourhoods with highest and lowest socioeconomic position (unemployment rate, per capita income) declined from about 30/100,000 person-years in the 1996 population cohort to 8/100,000 person-years in the 2001 population cohort. The absolute difference in mortality between individuals with the highest and lowest socioeconomic position fell from about 60/100,000 person-years in the first cohort to about 20/100,000 in the second. Relative differences in mortality by neighbourhood socioeconomic position and by individual education level also decreased in the 2001 cohort with respect to the 1996 cohort. Although relative differences by individual occupation increased, there was no evidence of a significant change. These findings show major reduction in absolute socioeconomic differences in AIDS mortality after HAART and indicate that the use of relative differences alone may be inadequate to fully evaluate the results of health interventions.</description><subject>Absolute differences</subject><subject>Acquired Immune Deficiency Syndrome</subject><subject>Acquired Immunodeficiency Syndrome - drug therapy</subject><subject>Acquired Immunodeficiency Syndrome - mortality</subject><subject>Adult</subject><subject>AIDS</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral Therapy, Highly Active - utilization</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Death</subject><subject>Differences</subject><subject>Drug therapy</subject><subject>Epidemiology</subject><subject>Female</subject><subject>General aspects</subject><subject>HAART</subject><subject>HAART AIDS Measures of inequities in health Relative differences Absolute differences Spain Neighbourhoods</subject><subject>Health</subject><subject>Health inequality</subject><subject>Health Status Disparities</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Inequality</subject><subject>Infectious diseases</subject><subject>Intervention</subject><subject>Male</subject><subject>Measurement</subject><subject>Measures of inequities in health</subject><subject>Medical Record Linkage</subject><subject>Medical sciences</subject><subject>Medical treatment</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Mortality</subject><subject>Neighborhoods</subject><subject>Neighbourhoods</subject><subject>Poverty</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Registries</subject><subject>Relative differences</subject><subject>Residence Characteristics - classification</subject><subject>Social Class</subject><subject>Socioeconomic status</subject><subject>Spain</subject><subject>Spain - epidemiology</subject><subject>Survival Analysis</subject><subject>Urban Health - classification</subject><subject>Urban Health - statistics & numerical data</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. 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Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Registries</topic><topic>Relative differences</topic><topic>Residence Characteristics - classification</topic><topic>Social Class</topic><topic>Socioeconomic status</topic><topic>Spain</topic><topic>Spain - epidemiology</topic><topic>Survival Analysis</topic><topic>Urban Health - classification</topic><topic>Urban Health - statistics & numerical data</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. 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Two population cohorts were constructed by linking records from 1996 and 2001 population censuses with mortality registry records after initial and full implementation of HAART, respectively. Absolute and relative differences in AIDS mortality in people aged 20–49 years were estimated in each population cohort according to neighbourhood and individual socioeconomic position. The absolute difference in mortality between neighbourhoods with highest and lowest socioeconomic position (unemployment rate, per capita income) declined from about 30/100,000 person-years in the 1996 population cohort to 8/100,000 person-years in the 2001 population cohort. The absolute difference in mortality between individuals with the highest and lowest socioeconomic position fell from about 60/100,000 person-years in the first cohort to about 20/100,000 in the second. Relative differences in mortality by neighbourhood socioeconomic position and by individual education level also decreased in the 2001 cohort with respect to the 1996 cohort. Although relative differences by individual occupation increased, there was no evidence of a significant change. These findings show major reduction in absolute socioeconomic differences in AIDS mortality after HAART and indicate that the use of relative differences alone may be inadequate to fully evaluate the results of health interventions.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>19056156</pmid><doi>10.1016/j.socscimed.2008.10.039</doi><tpages>8</tpages></addata></record> |
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| ispartof | Social science & medicine (1982), 2009-02, Vol.68 (3), p.419-426 |
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| subjects | Absolute differences Acquired Immune Deficiency Syndrome Acquired Immunodeficiency Syndrome - drug therapy Acquired Immunodeficiency Syndrome - mortality Adult AIDS Antiretroviral drugs Antiretroviral Therapy, Highly Active - utilization Biological and medical sciences Cohort Studies Death Differences Drug therapy Epidemiology Female General aspects HAART HAART AIDS Measures of inequities in health Relative differences Absolute differences Spain Neighbourhoods Health Health inequality Health Status Disparities Human viral diseases Humans Inequality Infectious diseases Intervention Male Measurement Measures of inequities in health Medical Record Linkage Medical sciences Medical treatment Middle Aged Miscellaneous Mortality Neighborhoods Neighbourhoods Poverty Public health. Hygiene Public health. Hygiene-occupational medicine Registries Relative differences Residence Characteristics - classification Social Class Socioeconomic status Spain Spain - epidemiology Survival Analysis Urban Health - classification Urban Health - statistics & numerical data Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Vulnerable Populations - statistics & numerical data Young Adult |
| title | Major reduction in AIDS-mortality inequalities after HAART: The importance of absolute differences in evaluating interventions |
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