Advances in Preventive Medicine

Research Article

Widening Socioeconomic, Racial, and Geographic Disparities in HIV/AIDS Mortality in the United States, 1987–2011

Table 3

Poisson regression models showing relative risk (RR) of HIV/AIDS mortality according to socioeconomic deprivation, urbanization level, primary medical care shortage areas, health uninsurance rate, and racial composition, United States, 1992–1995 and 2003–2007.


	2003–2007				1992–1995
	Age-adjusted		Covariate-adjusted		Age-adjusted		Covariate-adjusted
	RR	95% CI	RR	95% CI	RR	95% CI	RR	95% CI

Total US population
Socioeconomic deprivation index
Quintile 1 (low SES)	4.40	4.27–4.53	2.25	2.17–2.34	2.19	2.15–2.22	0.92	0.90–0.94
Quintiles 2–4 (middle SES)	2.13	2.07–2.19	1.68	1.64–1.73	1.44	1.42–1.46	0.90	0.89–0.92
Quintile 5 (high SES)	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
Urbanization level
Large metro. counties¹	3.20	2.87–3.57	3.88	3.48–4.33	4.04	3.71–4.40	6.73	6.18–7.33
Medium metro. counties²	2.18	1.95–2.43	2.98	2.67–3.33	2.43	2.23–2.65	4.93	4.53–5.38
Small metro counties³	1.58	1.41–1.77	2.09	1.86–2.34	1.68	1.53–1.83	3.31	3.04–3.62
Urban nonmetro. counties⁴	1.53	1.36–1.71	1.71	1.53–1.92	1.42	1.30–1.55	2.05	1.88–2.24
Rural counties⁵	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
Health professional shortage area
Underserved	2.27	2.21–2.34	1.28	1.24–1.32	2.27	2.23–2.32	1.22	1.20–1.25
Not underserved	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
Health uninsurance rate⁶	1.44	1.43–1.45	1.14	1.12–1.15	1.39	1.39–1.40	1.45	1.44–1.46
Percent of black population⁷	1.50	1.49–1.51	1.38	1.38–1.39	1.33	1.32–1.33	1.28	1.27–1.28
Total black population
Socioeconomic deprivation index
Quintile 1 (low SES)	2.47	2.38–2.58	2.17	2.06–2.28	1.31	1.27–1.35	1.22	1.18–1.27
Quintiles 2–4 (middle SES)	1.63	1.57–1.69	1.55	1.49–1.61	1.02	1.00–1.05	0.95	0.93–0.98
Quintile 5 (high SES)	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
Urbanization level
Large metro. counties	2.37	2.03–2.78	3.49	2.98–4.08	3.72	3.19–4.33	4.58	3.93–5.34
Medium metro. counties	1.94	1.66–2.28	2.95	2.51–3.46	2.49	2.13–2.90	3.36	2.88–3.92
Small metro. counties	1.46	1.24–1.71	2.05	1.74–2.41	1.52	1.30–1.78	1.95	1.67–2.29
Urban nonmetro. counties	1.54	1.31–1.81	1.73	1.47–2.03	1.44	1.23–1.69	1.56	1.34–1.83
Rural counties	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
Health professional shortage area
Underserved	1.76	1.69–1.84	1.21	1.16–1.26	1.72	1.66–1.78	1.32	1.27–1.37
Not underserved	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
Health uninsurance rate	1.28	1.27–1.30	1.03	1.01–1.05	1.20	1.19–1.22	1.12	1.11–1.14
Percent of black population	1.17	1.16–1.18	1.10	1.10–1.11	1.08	1.07–1.08	1.03	1.02–1.04
Black male
Socioeconomic deprivation index
Quintile 1 (low SES)	2.42	2.30–2.54	2.10	1.97–2.24	1.32	1.28–1.36	1.23	1.18–1.29
Quintiles 2–4 (middle SES)	1.65	1.57–1.73	1.57	1.49–1.65	1.07	1.04–1.10	1.01	0.97–1.04
Quintile 5 (high SES)	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
Urbanization level
Large metro. counties	2.48	2.04–3.00	3.59	2.96–4.35	3.85	3.23–4.59	4.71	3.95–5.62
Medium metro. counties	2.07	1.70–2.51	3.09	2.54–3.76	2.55	2.13–3.04	3.39	2.84–4.05
Small metro. counties	1.54	1.26–1.88	2.17	1.78–2.65	1.58	1.32–1.89	2.03	1.70–2.44
Urban nonmetro. counties	1.55	1.28–1.89	1.76	1.45–2.15	1.45	1.21–1.74	1.59	1.33–1.91
Rural counties	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
Health professional shortage area
Underserved	1.74	1.65–1.83	1.19	1.13–1.26	1.75	1.68–1.83	1.32	1.27–1.38
Not underserved	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
Health uninsurance rate	1.27	1.25–1.29	1.02	1.01–1.05	1.19	1.17–1.20	1.10	1.08–1.11
Percent of black population	1.18	1.17–1.19	1.12	1.11–1.13	1.10	1.09–1.10	1.05	1.05–1.06
Black female
Socioeconomic deprivation index
Quintile 1 (low SES)	2.60	2.43–2.79	2.30	2.10–2.52	1.35	1.28–1.43	1.23	1.14–1.33
Quintiles 2–4 (middle SES)	1.61	1.51–1.72	1.53	1.42–1.65	0.93	0.88–0.98	0.84	0.79–0.89
Quintile 5 (high SES)	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
Urbanization level
Large metro. counties	2.43	1.85–3.20	3.70	2.81–4.87	3.86	2.83–5.28	4.97	3.64–6.80
Medium metro. counties	1.85	1.41–2.44	2.91	2.20–3.84	2.48	1.81–3.39	3.61	2.63–4.94
Small metro. counties	1.36	1.02–1.81	1.94	1.46–2.58	1.38	1.00–1.91	1.82	1.32–2.53
Urban nonmetro. counties	1.53	1.16–2.03	1.71	1.29–2.27	1.40	1.01–1.92	1.48	1.08–2.05
Rural counties	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
Health professional shortage area
Underserved	1.84	1.71–1.98	1.24	1.14–1.34	1.71	1.58–1.84	1.30	1.20–1.41
Not underserved	1.00	Reference	1.00	Reference	1.00	Reference	1.00	Reference
Health uninsurance rate	1.32	1.29–1.35	1.05	1.02–1.08	1.29	1.26–1.32	1.21	1.18–1.25
Percent of black population	1.16	1.15–1.18	1.08	1.07–1.10	1.06	1.05–1.07	0.99	0.98–1.00

¹Counties in metropolitan areas with 1 million population or more. ²Counties in metropolitan areas of 250,000–1,000,000 population. ³Counties in metropolitan areas with population < 250,000. ⁴Urban nonmetropolitan counties consisting mostly of small urban towns with population < 20,000. ⁵Rural counties with no places with a population of ≥2,500. ⁶Relative risk associated with each 5-percentage-point increase in the proportion of population without health insurance. ⁷Relative risk associated with each 10-percentage-point increase in the proportion of the black population in a county.