Abstract #221  -  Community co-factors, diffusion of innovation, and disparities in US HIV mortality
Authors:   Presenting Author:   Prof Robert Levine - Meharry Medical College
Additional Authors:  Dr. Vincent Agboto, Dr. Maria Pisu, Prof Paul Juarez, Prof Roger Zoorob, Prof J. Gary Linn, Prof Charles Hennekens,
Aim: Describe disparities in US mortality between blacks and whites upon introduction of Highly Active Anti-Retroviral Treatment (HAART) in 1996.
Method / Issue: Main outcome measures were: (a) pre- and post-innnovation age-gender-specific black:white mortality rate ratios and 95% confidence intervals for Human Immunodeficiency Virus disease (HIV); (b) zero-corrected, negative binomial analysis of black mortality rates and (c) multinoimal logistic regression using socio-demographic descriptors from the 1990 and 2000 US census to compare counties with post-innovation declines in both black mortality rate and black:white mortality rate ratio to counties less successful outcomes.
Results / Comments: Black:white mortality rate ratios increased as rates for both races declined. There was no consistent configuration of socio-demographic factors associated with counties having post-innovation declines in both black mortality rate and black:white mortality rate ratio although post-innovation mortality was more closely related to such factors.
Discussion: These data are consistent with the hypotheses that: (a) community co-factors are an important determinant of the real-world effectiveness for biologically efficacious HIV treatment; and (b) failure of federal law to address unequal diffusion of lifesaving treatments and health outcomes increased black:white disparities in mortality in the US. These observations may have relevance to international variations in the effectiveness of HIV treatment.
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