Applying the Fundamental Cause Framework to the Examination of Disparities in HIV/AIDS Mortality in the United States (US)

This study utilizes the fundamental cause framework to examine socioeconomic and racial disparities in US HIV/AIDS mortality over a 24-year period. When health innovations render a disease more treatable, those with greater access to social, economic, and political resources will disproportionately benefit, thereby triggering health disparities. We examine inequalities in HIV/AIDS mortality in light of major advances in capacity to delay death, primarily due to the introduction of highly active antiretroviral therapy (HAART). We combined death certificate data compiled by the National Center for Health Statistics with yearly population estimates from the US Census Bureau to derive county-level all-cause and cause-specific mortality rates by sex, race, and age. An aggregate measure of socioeconomic status (SES) was constructed using multiple county-level variables from the 1980-2000 Decennial Censuses. We employ fixed and random effects negative binomial regression analyses to answer three research questions. First, how has the social patterning of HIV/AIDS mortality changed during the time period of interest? Second, to what extent are longitudinal shifts in HIV/AIDS mortality associated with socioeconomic differentials? Finally, can we fully account for emerging racial disparities in HIV/AIDS mortality by differences in SES? A number of sensitivity analyses indicate that our findings are robust to changes in variable definitions and model specifications. Preliminary results suggest that recent transformations in the distribution of HIV/AIDS mortality since the introduction of HAART in 1995 are driven largely by existing SES differentials. Moreover, Black/White disparities in HIV/AIDS mortality cannot be solely attributable to differences in the availability of socioeconomic resources.