257806 Rural AIDS in Florida: Factors associated with acquired immunodeficiency syndrome survival

Tuesday, October 30, 2012

Mary Jo Trepka, MD, MSPH , Robert Stempel College of Public Health and Social Work, Department of epidemiology, Florida International University, Miami, FL
Theophile Niyonsenga, PhD , Epidemiology & Biostatistics, FIU Stempel School of Public Health, Miami, FL
Lorene Maddox, MPH , Bureau of HIV/AIDS, Florida Department of Health, Tallahassee, FL
Spencer Lieb, MPH , Florida Consortium for HIV/AIDS Research, The AIDS Institute, Tampa, FL
Background: To describe predictors of survival among people diagnosed with AIDS in rural Florida and compare these predictors with those in urban areas. Methods: Florida AIDS surveillance data for people diagnosed with AIDS during 1993-2004 were linked with Florida Vital Records, the Social Security Administration's Death Master File, and the National Death Index to ascertain deaths. AIDS deaths were merged with 2000 Census data using zip code tabulation areas (ZCTA). Rural status of ZCTA was classified based on the rural-urban commuting area coding of the ZCTA. Survival rates were compared between rural and urban areas using survival curves and Cox proportional hazards models controlling for demographic, clinical, and area-level socioeconomic and health care access factors. Results: Of the 59,528 AIDS cases diagnosed during 1993-2004, 1,073 (1.8%) were diagnosed in rural areas. The three-year survival rate was slightly higher in rural (70.8%) than in urban (68.1%) areas, but the difference was not statistically significant (P <0.054). There was no difference in the five-year or ten-year survival rates. In the Cox proportional hazards models, older age at the time of diagnosis, earlier year of diagnosis, other/unknown mode of transmission, lower CD4 count, a lower measure of material deprivation and low density of hospitals were associated with lower survival. Conclusions: In Florida there was no evidence that rural residents diagnosed with AIDS were disadvantaged with regard to AIDS survival. However, rural residents living in areas with a low density of hospitals were disadvantaged relative to other rural residents.

Learning Areas:

Learning Objectives:
Discuss factors related to lower AIDS survival in rural areas

Keywords: HIV/AIDS, Rural Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: "I have a Masters of Public Health degree and have extensive years of experience managing the Florida HIV/AIDS Surveillance System and using HIV/AIDS surveillance data.'
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.