The 130th Annual Meeting of APHA

Abstract #41281

Edward J. Lin, MPH, School of Medicine, University of Vermont, Given Box 209, 89 Beaumont Avenue, Burlington, VT 05405 and Richard Conviser, PhD, Service Evaluation and Research Branch, Office of Science and Epidemiology, HIV/AIDS Bureau, HRSA, 5600 Fishers Lane, Rm 7C-07, Rockville, MD 20857, 301-443-3075, Edward.Lin@uvm.edu.

Published studies show that income inequality is a better predictor than poverty of mortality and morbidity in countries with average incomes above a particular threshold ($5000 in 1990). Several indicators have been developed for income inequality. This study explores the association of eight such indicators with state-level HIV and AIDS incidence (in 1998-99 and 1999-2000) and prevalence (in 2000) in the U.S. Measures examined were the ratios of aggregate incomes for those in the top 10% vs. the bottom 10% of the population and the top vs. the bottom 20%; income ratios of those at the endpoints of these percentiles; total incomes in the bottom 50%, 60%, and 70% of the population; and the Gini ratio, a measure used widely in published studies. Only the Gini ratio was not significantly associated with AIDS incidence and prevalence. All measures of income inequality were significantly associated with HIV incidence, and none, with HIV prevalence; the 90%/10% aggregate ratio had the strongest associations.

The latter was then entered into regression models with several other potential predictors of AIDS incidence and prevalence, including the percentages of each state's population in poverty, urban, non-white, high school graduates, drug users, Medicaid-covered, and health-insured. In most models, income inequality had consistent significant associations with AIDS incidence in 1998-99 and AIDS prevalence in 2000, as did the percentages urban, non-white, and Medicaid-covered, but not the percentage in poverty. These findings suggest that social as well as individual-level changes may be necessary to bring the HIV epidemic under control.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Understand the concept of income inequality and compare eight indicators of it.
• Assess the association of income inequality with state-level HIV/AIDS incidence and prevalence rates in the U.S. relative to other explanatory variables, including poverty level.
• Recognize that these findings indicate a need for changes in our society's income distribution to improve public health.

Keywords: Social Inequalities, HIV/AIDS

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.