Racial disparities in AIDS survival, Florida, 1993-2007

Background: This study describes racial/ethnic survival patterns among Florida residents reported with an acquired immunodeficiency syndrome (AIDS) diagnosis to the Florida Human Immunodeficiency Virus/AIDS Reporting System from 1993 to 2005. Methods: Vital status was ascertained by linkage with Florida Vital Records, the Social Security Death Master File, and the National Death Index. We calculated adjusted Cox proportional hazard ratios (HR) for racial/ethnic groups, controlling for age, sex, mode of transmission, poverty, and birth place for the entire period and stratified in two-year intervals by time of AIDS diagnosis. Results: Of the 79,479 people in the cohort, 34,504 (43.4%) died between 1993 and 2007. For the entire period shorter survival times were associated with residence in areas with a high percentage of people living in poverty (HR comparing quartile living in the most to quartile living in the least impoverished areas: 1.33 [95% CI 1.28-1.38]); being an injection drug user (HR compared with being a man who has sex with men: 1.25 [95% CI 1.21-1.30)]; being US-born (HR 1.28 [95% CI 1.24-1.32]); being male (HR 1.06 [95% CI 1.03-1.09)]; and being of African-American race/ethnicity (HR compared with non-Hispanic white 1.15 [95% 1.11-1.18]). There was no difference in survival between Hispanics and non-Hispanic whites. Racial disparities peaked in 1996-1998 and thereafter declined to some extent. Socioeconomic disparities did not decline. Conclusions: African Americans and people living in high-poverty areas were at a higher risk for death throughout the study period. Racial/ethnic disparities diminished somewhat during the era of highly active antiretroviral therapy.