Black:White disparities in HIV mortality in 13 major U.S. cities: 1990-2009

Deaths due to HIV have declined substantially since the mid-1990’s when effective HIV treatment became widespread, yet not all populations in the US have benefitted equally.  This analysis will compare death rates for Blacks and Whites in 13 major US cities from 1990 – 2009.  Thirteen cities were selected for the analysis: the five most populous cities (New York, Los Angeles, Chicago, Philadelphia, and Houston), and eight additional cities which were among the top five metropolitan areas for HIV diagnoses in 2010 or 2011 (Washington, D.C., Memphis, Baltimore, Miami, Atlanta, New Orleans, Baton Rouge, and Jackson).  Using vital records from the National Center for Health Statistics and US Census data, we calculated the race- and gender-specific HIV mortality rates and corresponding racial rate ratios for non-Hispanic Blacks and non-Hispanic Whites in the US for four 5-year increments from 1990-2009.  Rates were age-adjusted using the 2000 US standard population.  Rate ratios were used to determine the level of disparity.  Baton Rouge and Jackson were excluded because there were not enough deaths to reliably calculate death rates among both Blacks and Whites.  We calculated excess Black deaths for 2005-2009.  For the total, male, and female populations, we observed a statistically significant increase in the Black:White HIV mortality disparity between T1 (1990-1994) and T4 (2005-2009) in every city included in the analysis.  The findings were consistent for both men and women.  By 2005-2009 the HIV mortality disparities ranged from 3.24 (New Orleans) to 14.21 (Washington, D.C.).   Among men, the disparities ranged from 3.17 (New Orleans) to 11.38 (Washington, D.C.)  and among women the disparities ranged from 5.42 (Philadelphia) to 9.66 (Los Angeles).  The increasing disparity was due to the fact that the decrease in mortality rates from T1 to T4 was greater among Whites than Blacks for every city included in the analysis.  This disparity lead to 5,603 excess Black deaths in the US at T4.  Previous research suggests that as HIV becomes more treatable, racial disparities widen, as observed in this study for both men and women in every city included in the analysis.  Data such as this coupled with local surveillance reports may serve as a means to learn from cities whose disparities are improving.   Additionally, existing disparities could be ameliorated if access to care were equal among these groups.