Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing

Ransome, Yusuf; Kawachi, Ichiro; Braunstein, Sarah L.; Nash, Denis

doi:10.1016/j.healthplace.2016.09.004

Cited by 89 publications

(65 citation statements)

References 85 publications

(93 reference statements)

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“…Greater health disparities in places with a greater concentration of black Americans is not unique to COVID-19. Similar patterns have been reported for other conditions such as HIV 27 , air pollution 28 , cancer 29 , and low birth weight 30 and may be derived from the fact that in the United States, race often determines place of residence. 31 Ninety-one percent of disproportionately black counties in these analyses are located in the southern United States -a region where most black Americans reside 32 (58%) that also ranks highest in unemployment, uninsurance, and limited health system capacity or investment.…”

Section: Discussionsupporting

confidence: 71%

Assessing Differential Impacts of COVID-19 on Black Communities

Millett

Jones

Benkeser

et al. 2020

Preprint

231

282

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were compared between disproportionately (>13%) black and all other (<13% black) counties. Rate ratios were calculated and population attributable fractions (PAF) were estimated using COVID-19 cases and deaths via zero-inflated negative binomial regression model. National maps with countylevel data and an interactive scatterplot of COVID-19 cases were generated. ResultsNearly ninety-seven percent of disproportionately black counties (656/677) reported a case and 49% (330/677) reported a death versus 81% (1987/2,465) and 28% (684/ 2465), respectively, for all other counties. Counties with higher proportions of black people have higher prevalence of comorbidities and greater air pollution. Counties with higher proportions of black residents had more COVID-19 diagnoses (RR 1.24, 95% CI 1.17-1.33) and deaths (RR 1.18, 95% CI 1.00-1.40), after adjusting for county-level characteristics such as age, poverty, comorbidities, and epidemic duration. COVID-19 deaths were higher in disproportionally black rural and small metro counties. The PAF of COVID-19 diagnosis due to lack of health insurance was 3.3% for counties with <13% black residents and 4.2% for counties with >13% black residents.

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Section: Discussionsupporting

confidence: 71%

Assessing Differential Impacts of COVID-19 on Black Communities

Millett

Jones

Benkeser

et al. 2020

Preprint

231

282

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“…It may be contrary to expectations that the outbreak rate of a new pathogen, which is able to infect virtually anyone, manifests contextual disparities. But for other conditions, such as HIV and cancer, regional health disparities have been reported before, 32,33 and with the current study we show that contextual factors in the U.S. also create a variation in COVID-19 cases. Our analysis indicates that higher outbreak rates can be found in U.S. states characterized by a higher cultural value of collectivism (coefficient 0.998, confidence interval [0.351; 1.645], p = 0.004).…”

Section: Discussionsupporting

confidence: 79%

The Influence of Contextual Factors on the Initial Phases of the COVID-19 Outbreak across U.S. Counties

Messner

Payson

2020

Preprint

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Objectives.To examine the influence of county-and state-level characteristics on the initial phases of the COVID-19 outbreak across U.S. counties up to April 14, 2020. Methods. We used a statistical exponential growth model for the outbreak. Contextual factors at county-and state-level were simultaneously tested with a multilevel linear model. All data was publicly available. Results. Collectivism was positively associated with the outbreak rate. The racial and ethnic composition of counties contributed to outbreak differences, affecting Black/African and Asian Americans most. Counties with a higher median age had a stronger outbreak, as did counties with more people below the age of 18. Higher income, education, and personal health were generally associated with a lower outbreak. Obesity was negatively related to the outbreak. Smoking was negatively related, but only directionally informative. Air pollution was another significant contributor to the outbreak, but population density did not give statistical significance. Conclusions. Because of high intrastate and intercounty variation in contextual factors, policy makers need to target pandemic responses to the smallest subdivision possible, so that countermeasures can be implemented effectively.

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“…Alternately, the findings may be due to unobserved confounding or interaction with other sociocontextual factors. For example, a recent study in New York City showed that late HIV diagnosis was high in areas with low black racial concentration and high income inequality and areas with high black racial concentration and low income inequality [81] .…”

Section: Discussionmentioning

confidence: 99%

“…For all models, a-priori we included black racial composition and income inequality given a specific interest based on empirical evidence from prior research [50] . We used multinomial logistic regression and selected the “priority” cluster described above as the reference group.…”

Section: Methodsmentioning

confidence: 99%

“…Once clusters are identified between social capital and HIV care continuum, the next step is to analyze what sociocontextual mechanisms distinguish those clusters. Sex distribution, racial composition, socio-economic position, access to treatment, and elements of the built environment such as alcohol outlets, which can suggest neighborhood disorder, are sociocontextual factors that influence the distribution of social capital [45–49] as well as HIV/AIDS outcomes [50–52] . Therefore, those are important mechanisms to analyze in relation to geographic clustering.…”

Section: Introductionmentioning

confidence: 99%

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How Do Social Capital and HIV/AIDS Outcomes Geographically Cluster and Which Sociocontextual Mechanisms Predict Differences Across Clusters?

Ransome

Dean

Crawford

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Place of residence has been associated with HIV transmission risks. Social capital, defined as features of social organization that improve efficiency of society by facilitating coordinated actions, often varies by neighborhood, and hypothesized to have protective effects on HIV care continuum outcomes. We examined whether the association between social capital and two HIV care continuum outcomes clustered geographically and whether sociocontextual mechanisms predict differences across clusters. Methods Bivariate Local Moran’s I evaluated geographical clustering in the association between social capital (participation in civic & social organizations, 2006, 2008, 2010) and (5-year [2007–2011] prevalence of late HIV diagnosis and linkage to HIV care) across Philadelphia, PA census tracts (N = 378). Maps documented the clusters and multinomial regression assessed which sociocontextual mechanisms (e.g., racial composition) predict differences across clusters. Results We identified four significant clusters (high social capital-high HIV/AIDS, low social capital –low HIV/AIDS, low social capital-high HIV/AIDS, and high social capital-low HIV/AIDS). Moran’s I between social capital and late HIV diagnosis was (I=0.19, z=9.54, p<.001) and linkage to HIV care (I=0.06, z=3.274, p=0.002). In multivariable analysis, median household income predicted differences across clusters, particularly where social capital was lowest and HIV burden the highest, compared to clusters with high social capital and lowest HIV burden. Discussion The association between social participation and HIV care continuum outcomes cluster geographically in Philadelphia, PA. HIV prevention interventions should account for this phenomenon. Reducing geographic disparities will require interventions tailored to each continuum step and that address socioeconomic factors such as neighborhood median income.

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Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing

Cited by 89 publications

References 85 publications

Assessing Differential Impacts of COVID-19 on Black Communities

Assessing Differential Impacts of COVID-19 on Black Communities

The Influence of Contextual Factors on the Initial Phases of the COVID-19 Outbreak across U.S. Counties

How Do Social Capital and HIV/AIDS Outcomes Geographically Cluster and Which Sociocontextual Mechanisms Predict Differences Across Clusters?

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