Disparities in AIDS survival among US-born and foreign-born non-hispanic black Florida residents, 1996-2004

Background: This study compares survival patterns by country of birth among non-Hispanic Black (NHB) Florida residents diagnosed with acquired immunodeficiency syndrome (AIDS) from 1996 to 2004. Methods: Data obtained from the Florida HIV/AIDS Surveillance System were linked with Florida Vital Records, the Social Security Death Master File and the National Death Index to ascertain vital status through 2007. Participants were categorized based on race/ethnicity and country of birth. People born in English-speaking Caribbean Islands (ESCI) were aggregated into one category. Hazards ratios (HR) for ethnic/country of birth groups, adjusted for age, gender, year of diagnosis, transmission category and CD4 count/percent, were calculated in SAS, by weighted Cox regression to address nonproportionality. Results: Countries of birth of the 24,229 NHB in the cohort were: USA (80.0%); Haiti (15.0%); ESCI (3.2%); and other countries or unknown country of birth (1.8%). Overall, 10,339 deaths were recorded. Significantly shorter survival was associated with being born in the US compared to being born in Haiti (HR: 1.59; 95%CI: 1.49-1.70), and in ESCI (HR: 1.30; 95%CI: 1.15-1.47). ESCI-born NHB had shorter survival than Haitian-born NHB (HR: 1.22; 95%CI: 1.07-1.40). Conclusions: Among Florida residents diagnosed with AIDS, US-born Blacks were at higher risk of death than foreign-born Blacks. There was a Haitian-born survival advantage compared to other AIDS-diagnosed NHB born in the US or in ESCI. Further research is needed to determine if these observations are due to cultural differences, potential salmon bias (immigrants returning home to die), or persistence of healthy migrant effect even with AIDS.