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

Authors


  • Funding: The project described was supported by Award Number R01MD004002 from the National Institute on Minority Health and Health Disparities at the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Minority Health and Health Disparities or the National Institutes of Health.

  • Acknowledgments: The authors wish to thank Tracina Bush, BS; Julia Fitz, MPH; Khaleeq Lutfi, MPH; and Elena McCalla-Pavlova, MD, MHSA, for assistance in preparing the data set.

For further information, contact: Mary Jo Trepka, MD, MSPH, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC II, Room 595, 11200 SW 8th Street; Miami, FL 33199; e-mail: trepkam@fiu.edu.

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 (ZCTAs). 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.

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