Infection with the human immunodeficiency virus (HIV) that causes AIDS is spreading at a disproportionately faster rate among blacks and Hispanics. These groups are also more apt to be uninsured and have less access to care than other groups. However, the shorter survival of HIV-infected Hispanics compared with HIV-infected blacks and whites is not explained by less access to general care or by HIV-specific treatment of Hispanics, according to a study supported in part by the Agency for Healthcare Research and Quality (minority supplement to HIV outcomes grant HS06775). The study findings were based on a 6-year followup of 200 adults with moderately advanced disease (mean CD4 count of 142), who were hospitalized at seven Los Angeles area hospitals for HIV-related illness during 1992 and 1993.
Researchers at the University of California, Los Angeles, compared the relative risk of 6-year mortality for Hispanic, black, and white patients, after controlling for sociodemographic factors (for example, access to care and insurance) and clinical characteristics (for example, severity of illness and disease stage). Overall, Hispanics had double the risk of dying during the 6 years than whites. Hispanics had median survival times that were more than 8 months shorter than whites (16 vs. 24 months) and less than half that of blacks (16 vs. 35 months).
Neither patient sociodemographic or clinical characteristics nor general access to care (for instance, insurance or regular care provider) or AIDS-specific treatment (for example, use of antiretroviral medications) prior to hospitalization eliminated or diminished the effect of Hispanic ethnicity on lower rates of survival. Patient age and sex were not significantly associated with survival. The researchers cite the urgent need to develop interventions to overcome gaps in the health system serving the growing number of Hispanics with HIV disease.
For more details, see "Ethnic and racial differences in long-term survival from hospitalization for HIV infection," by William E. Cunningham, M.D., M.P.H., David M. Mosen, Ph.D., Leo S. Morales, M.D., M.P.H., and others, in the Journal of Health Care for the Poor and Underserved 11(2), pp. 163-178, 2000.