Spatial and temporal analysis of HIV clinical outcomes in Florida reveals counties with persistent racial and ethnic disparities during 2012-2019
Abstract Background Racial/ethnic disparities in the HIV care continuum have been well documented in the US, with especially striking inequalities in viral suppression rates between White and Black persons with HIV (PWH). The South is considered an epicenter of the HIV epidemic in the US, with the l...
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-024-17944-w |
| _version_ | 1797266542669332480 |
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| author | Shannan N Rich Yiyang Liu Rebecca Fisk-Hoffman Yi Zheng Hui Hu Emma E Spencer Robert L Cook Mattia Prosperi |
| author_facet | Shannan N Rich Yiyang Liu Rebecca Fisk-Hoffman Yi Zheng Hui Hu Emma E Spencer Robert L Cook Mattia Prosperi |
| author_sort | Shannan N Rich |
| collection | DOAJ |
| description | Abstract Background Racial/ethnic disparities in the HIV care continuum have been well documented in the US, with especially striking inequalities in viral suppression rates between White and Black persons with HIV (PWH). The South is considered an epicenter of the HIV epidemic in the US, with the largest population of PWH living in Florida. It is unclear whether any disparities in viral suppression or immune reconstitution—a clinical outcome highly correlated with overall prognosis—have changed over time or are homogenous geographically. In this analysis, we 1) investigate longitudinal trends in viral suppression and immune reconstitution among PWH in Florida, 2) examine the impact of socio-ecological factors on the association between race/ethnicity and clinical outcomes, 3) explore spatial and temporal variations in disparities in clinical outcomes. Methods Data were obtained from the Florida Department of Health for 42,369 PWH enrolled in the Ryan White program during 2008-2020. We linked the data to county-level socio-ecological variables available from County Health Rankings. GEE models were fit to assess the effect of race/ethnicity on immune reconstitution and viral suppression longitudinally. Poisson Bayesian hierarchical models were fit to analyze geographic variations in racial/ethnic disparities while adjusting for socio-ecological factors. Results Proportions of PWH who experienced viral suppression and immune reconstitution rose by 60% and 45%, respectively, from 2008-2020. Odds of immune reconstitution and viral suppression were significantly higher among White [odds ratio =2.34, 95% credible interval=2.14-2.56; 1.95 (1.85-2.05)], and Hispanic [1.70 (1.54-1.87); 2.18(2.07-2.31)] PWH, compared with Black PWH. These findings remained unchanged after accounting for socio-ecological factors. Rural and urban counties in north-central Florida saw the largest racial/ethnic disparities. Conclusions There is persistent, spatially heterogeneous, racial/ethnic disparity in HIV clinical outcomes in Florida. This disparity could not be explained by socio-ecological factors, suggesting that further research on modifiable factors that can improve HIV outcomes among Black and Hispanic PWH in Florida is needed. |
| first_indexed | 2024-04-25T01:02:21Z |
| format | Article |
| id | doaj.art-0a9db55a434549a9858b507cee97a892 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-25T01:02:21Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-0a9db55a434549a9858b507cee97a8922024-03-10T12:23:49ZengBMCBMC Public Health1471-24582024-03-0124111010.1186/s12889-024-17944-wSpatial and temporal analysis of HIV clinical outcomes in Florida reveals counties with persistent racial and ethnic disparities during 2012-2019Shannan N Rich0Yiyang Liu1Rebecca Fisk-Hoffman2Yi Zheng3Hui Hu4Emma E Spencer5Robert L Cook6Mattia Prosperi7Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of FloridaDepartment of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of FloridaDepartment of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of FloridaChanning Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical SchoolChanning Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical SchoolFlorida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, HIV/AIDS SectionDepartment of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of FloridaDepartment of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of FloridaAbstract Background Racial/ethnic disparities in the HIV care continuum have been well documented in the US, with especially striking inequalities in viral suppression rates between White and Black persons with HIV (PWH). The South is considered an epicenter of the HIV epidemic in the US, with the largest population of PWH living in Florida. It is unclear whether any disparities in viral suppression or immune reconstitution—a clinical outcome highly correlated with overall prognosis—have changed over time or are homogenous geographically. In this analysis, we 1) investigate longitudinal trends in viral suppression and immune reconstitution among PWH in Florida, 2) examine the impact of socio-ecological factors on the association between race/ethnicity and clinical outcomes, 3) explore spatial and temporal variations in disparities in clinical outcomes. Methods Data were obtained from the Florida Department of Health for 42,369 PWH enrolled in the Ryan White program during 2008-2020. We linked the data to county-level socio-ecological variables available from County Health Rankings. GEE models were fit to assess the effect of race/ethnicity on immune reconstitution and viral suppression longitudinally. Poisson Bayesian hierarchical models were fit to analyze geographic variations in racial/ethnic disparities while adjusting for socio-ecological factors. Results Proportions of PWH who experienced viral suppression and immune reconstitution rose by 60% and 45%, respectively, from 2008-2020. Odds of immune reconstitution and viral suppression were significantly higher among White [odds ratio =2.34, 95% credible interval=2.14-2.56; 1.95 (1.85-2.05)], and Hispanic [1.70 (1.54-1.87); 2.18(2.07-2.31)] PWH, compared with Black PWH. These findings remained unchanged after accounting for socio-ecological factors. Rural and urban counties in north-central Florida saw the largest racial/ethnic disparities. Conclusions There is persistent, spatially heterogeneous, racial/ethnic disparity in HIV clinical outcomes in Florida. This disparity could not be explained by socio-ecological factors, suggesting that further research on modifiable factors that can improve HIV outcomes among Black and Hispanic PWH in Florida is needed.https://doi.org/10.1186/s12889-024-17944-wHIVSpatial-temporal epidemiologyClinical outcomesRacial disparitiesHIV in the South |
| spellingShingle | Shannan N Rich Yiyang Liu Rebecca Fisk-Hoffman Yi Zheng Hui Hu Emma E Spencer Robert L Cook Mattia Prosperi Spatial and temporal analysis of HIV clinical outcomes in Florida reveals counties with persistent racial and ethnic disparities during 2012-2019 BMC Public Health HIV Spatial-temporal epidemiology Clinical outcomes Racial disparities HIV in the South |
| title | Spatial and temporal analysis of HIV clinical outcomes in Florida reveals counties with persistent racial and ethnic disparities during 2012-2019 |
| title_full | Spatial and temporal analysis of HIV clinical outcomes in Florida reveals counties with persistent racial and ethnic disparities during 2012-2019 |
| title_fullStr | Spatial and temporal analysis of HIV clinical outcomes in Florida reveals counties with persistent racial and ethnic disparities during 2012-2019 |
| title_full_unstemmed | Spatial and temporal analysis of HIV clinical outcomes in Florida reveals counties with persistent racial and ethnic disparities during 2012-2019 |
| title_short | Spatial and temporal analysis of HIV clinical outcomes in Florida reveals counties with persistent racial and ethnic disparities during 2012-2019 |
| title_sort | spatial and temporal analysis of hiv clinical outcomes in florida reveals counties with persistent racial and ethnic disparities during 2012 2019 |
| topic | HIV Spatial-temporal epidemiology Clinical outcomes Racial disparities HIV in the South |
| url | https://doi.org/10.1186/s12889-024-17944-w |
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