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

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.