142nd APHA Annual Meeting and Exposition

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315255
Geographic variations in racial/ethnic disparities in HIV among injection drug users in the United States

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 12:30 PM - 12:50 PM

Sabriya Linton, PhD, MPH , Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA
Hannah LF Cooper, ScD, SM , Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA
Mary Kelley, PhD , Department of Biostatistics and Bioinformatics, Rollins School of Public Health at Emory University, Atlanta, GA
Conny Karnes, MA , Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA
Zev Ross , ZevRoss Spatial Analytics, Ithaca, NY
Mary Wolfe, MPH, CHES , Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA
Samuel R. Friedman, PhD , Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY
Don Des Jarlais, PhD , The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Barbara Tempalski, PhD, MPH , Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY
Elizabeth DiNenno, PhD , Centers for Disease Control and Prevention, Atlanta, GA
Cyprian Wejnert, PhD , Centers for Disease Control and Prevention, Atlanta, GA
Salaam Semaan, DrPH , Centers for Disease Control and Prevention, Atlanta, GA
Gabriela Paz-Bailey, MD, PhD, MSc , Centers for Disease Control and Prevention, Atlanta, GA
Background: Research suggests that geographic factors are important determinants of racial/ethnic disparities in HIV/AIDS in the United States. However, most of these studies have evaluated social and structural factors at a single geographic unit. This may limit the analytic depth and policy implications of these studies. This descriptive study explores whether variance in HIV infection among people who inject drugs (PWID) is partitioned differently across multiple geographic units and by race/ethnicity.

Methods: Multilevel logistic regression was used to partition variance in the odds of testing positive for HIV across three hierarchical geographic units (i.e., ZIP codes, counties, metropolitan statistical areas [MSAs]) among 9,079 PWID recruited via respondent-driven sampling in 2009 from 19 MSAs as part of the Centers for Disease Control and Prevention National HIV Behavioral Surveillance System. Two multilevel models were created: the first included random intercepts for each geographic level; the second included random intercepts for each geographic level for three racial/ethnic groups (i.e. non-Hispanic White, non-Hispanic Black, Latino). Models did not include other covariates. Stata software was used.

Results: Overall, 19% of the variance in HIV infection was apportioned to geographic units. When race/ethnicity was included in analysis, 31% of the variance was apportioned to geographic units. The total variance apportioned to geographic units was highest for non-Hispanic Whites, and the relative contribution of each geographic unit varied by race/ethnicity (Table 1).

Table 1. Percent variance in HIV by geographic unit and race/ethnicity, among 9,079 PWID

Geographic unit

Percent variance in HIV apportioned to geographic units

 

All racial/ethnic groups (N=9,079)

Non-Hispanic Whites (N=2752)

Non-Hispanic Blacks (N=4687)

Latinos (N=1640)

ZIP code

4.3

4.3

0.0

0.0

County

9.2

2.3

6.9

0.0

MSA

17.6

7.5

0.0

10.1

Total

31.1

14.1

6.9

10.1

Discussion:  Racial/ethnic differences in the overall variance in HIV and in the distribution of variance across geographic units were observed. Place appears to be an important factor for HIV among PWID, and the geographic scale that is most influential appears to differ by race/ethnicity. Studies should evaluate social determinants across multiple geographic units, including smaller geographic units, to inform the development of comprehensive strategies that incorporate place-based interventions.

Learning Areas:

Epidemiology

Learning Objectives:
Demonstrate how multilevel methods can be used to describe how variance in HIV is apportioned differently across multiple geographic units and by race/ethnicity Discuss why future research on place and racial/ethnic health disparities should investigate the role of place at multiple geographic units

Keyword(s): HIV/AIDS, Drug Abuse

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: For the past 5 years I have contributed to the conception, analysis, and dissemination of research focused on the social epidemiology of substance use and HIV/STIs. My research as a postdoctoral fellow is focused on substance use and HIV/STIs at the intersection of place characteristics, homelessness, and social networks.
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.