The effects of social determinants of health on acquired immune deficiency syndrome in a low-income population of Brazil: a retrospective cohort study of 28.3 million individualsResearch in context
Summary: Background: Social determinants of health (SDH) include factors such as income, education, and race, that could significantly affect the human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS). Studies on the effects of SDH on HIV/AIDS are limited, and do not yet pro...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-08-01
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| Series: | The Lancet Regional Health. Americas |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667193X2300128X |
| _version_ | 1797777411886022656 |
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| author | Iracema Lua Andrea F. Silva Nathalia S. Guimarães Laio Magno Julia Pescarini Rodrigo V.R. Anderle Maria Yury Ichihara Mauricio L. Barreto Carlos A.S. Teles Santos Louisa Chenciner Luis Eugênio Souza James Macinko Ines Dourado Davide Rasella |
| author_facet | Iracema Lua Andrea F. Silva Nathalia S. Guimarães Laio Magno Julia Pescarini Rodrigo V.R. Anderle Maria Yury Ichihara Mauricio L. Barreto Carlos A.S. Teles Santos Louisa Chenciner Luis Eugênio Souza James Macinko Ines Dourado Davide Rasella |
| author_sort | Iracema Lua |
| collection | DOAJ |
| description | Summary: Background: Social determinants of health (SDH) include factors such as income, education, and race, that could significantly affect the human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS). Studies on the effects of SDH on HIV/AIDS are limited, and do not yet provide a systematic understanding of how the various SDH act on important indicators of HIV/AIDS progression. We aimed to evaluate the effects of SDH on AIDS morbidity and mortality. Methods: A retrospective cohort of 28.3 million individuals was evaluated over a 9-year period (from 2007 to 2015). Multivariable Poisson regression, with a hierarchical approach, was used to estimate the effects of SDH—at the individual and familial level—on AIDS incidence, mortality, and case-fatality rates. Findings: A total of 28,318,532 individuals, representing the low-income Brazilian population, were assessed, who had a mean age of 36.18 (SD: 16.96) years, 52.69% (14,920,049) were female, 57.52% (15,360,569) were pardos, 34.13% (9,113,222) were white/Asian, 7.77% (2,075,977) were black, and 0.58% (154,146) were indigenous. Specific socioeconomic, household, and geographic factors were significantly associated with AIDS-related outcomes. Less wealth was strongly associated with a higher AIDS incidence (rate ratios—RR: 1.55; 95% confidence interval—CI: 1.43–1.68) and mortality (RR: 1.99; 95% CI: 1.70–2.34). Lower educational attainment was also greatly associated with higher AIDS incidence (RR: 1.46; 95% CI: 1.26–1.68), mortality (RR: 2.76; 95% CI: 1.99–3.82) and case-fatality rates (RR: 2.30; 95% CI: 1.31–4.01). Being black was associated with a higher AIDS incidence (RR: 1.53; 95% CI: 1.45–1.61), mortality (RR: 1.69; 95% CI: 1.57–1.83) and case-fatality rates (RR: 1.16; 95% CI: 1.03–1.32). Overall, also considering the other SDH, individuals experiencing greater levels of socioeconomic deprivation were, by far, more likely to acquire AIDS, and to die from it. Interpretation: In the population studied, SDH related to poverty and social vulnerability are strongly associated with a higher burden of HIV/AIDS, most notably less wealth, illiteracy, and being black. In the absence of relevant social protection policies, the current worldwide increase in poverty and inequalities—due to the consequences of the COVID-19 pandemic, and the effects of war in the Ukraine—could reverse progress made in the fight against HIV/AIDS in low- and middle-income countries (LMIC). Funding: National Institute of Allergy and Infectious Diseases (NAIDS), National Institutes of Health (NIH), US Grant Number: 1R01AI152938. |
| first_indexed | 2024-03-12T23:04:36Z |
| format | Article |
| id | doaj.art-57106cbbfa974c81a2ccb3529ead1592 |
| institution | Directory Open Access Journal |
| issn | 2667-193X |
| language | English |
| last_indexed | 2024-03-12T23:04:36Z |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Americas |
| spelling | doaj.art-57106cbbfa974c81a2ccb3529ead15922023-07-19T04:24:01ZengElsevierThe Lancet Regional Health. Americas2667-193X2023-08-0124100554The effects of social determinants of health on acquired immune deficiency syndrome in a low-income population of Brazil: a retrospective cohort study of 28.3 million individualsResearch in contextIracema Lua0Andrea F. Silva1Nathalia S. Guimarães2Laio Magno3Julia Pescarini4Rodrigo V.R. Anderle5Maria Yury Ichihara6Mauricio L. Barreto7Carlos A.S. Teles Santos8Louisa Chenciner9Luis Eugênio Souza10James Macinko11Ines Dourado12Davide Rasella13Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil; Department of Health, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, BrazilInstitute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, BrazilInstitute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, BrazilDepartment of Life Sciences, State University of Bahia (UNEB), Salvador, Bahia, BrazilCenter for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UKInstitute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, BrazilCenter for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, BrazilInstitute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, BrazilCenter for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, BrazilNuffield Department of Population Health, University of Oxford, Richard Doll Building, Oxford, UK; Oxford University Hospitals, Oxford, UK; Department of Infection and Immunity, St George's University London, London, UKInstitute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, BrazilDepartments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USAInstitute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, BrazilInstitute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil; ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain; Corresponding author. Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.Summary: Background: Social determinants of health (SDH) include factors such as income, education, and race, that could significantly affect the human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS). Studies on the effects of SDH on HIV/AIDS are limited, and do not yet provide a systematic understanding of how the various SDH act on important indicators of HIV/AIDS progression. We aimed to evaluate the effects of SDH on AIDS morbidity and mortality. Methods: A retrospective cohort of 28.3 million individuals was evaluated over a 9-year period (from 2007 to 2015). Multivariable Poisson regression, with a hierarchical approach, was used to estimate the effects of SDH—at the individual and familial level—on AIDS incidence, mortality, and case-fatality rates. Findings: A total of 28,318,532 individuals, representing the low-income Brazilian population, were assessed, who had a mean age of 36.18 (SD: 16.96) years, 52.69% (14,920,049) were female, 57.52% (15,360,569) were pardos, 34.13% (9,113,222) were white/Asian, 7.77% (2,075,977) were black, and 0.58% (154,146) were indigenous. Specific socioeconomic, household, and geographic factors were significantly associated with AIDS-related outcomes. Less wealth was strongly associated with a higher AIDS incidence (rate ratios—RR: 1.55; 95% confidence interval—CI: 1.43–1.68) and mortality (RR: 1.99; 95% CI: 1.70–2.34). Lower educational attainment was also greatly associated with higher AIDS incidence (RR: 1.46; 95% CI: 1.26–1.68), mortality (RR: 2.76; 95% CI: 1.99–3.82) and case-fatality rates (RR: 2.30; 95% CI: 1.31–4.01). Being black was associated with a higher AIDS incidence (RR: 1.53; 95% CI: 1.45–1.61), mortality (RR: 1.69; 95% CI: 1.57–1.83) and case-fatality rates (RR: 1.16; 95% CI: 1.03–1.32). Overall, also considering the other SDH, individuals experiencing greater levels of socioeconomic deprivation were, by far, more likely to acquire AIDS, and to die from it. Interpretation: In the population studied, SDH related to poverty and social vulnerability are strongly associated with a higher burden of HIV/AIDS, most notably less wealth, illiteracy, and being black. In the absence of relevant social protection policies, the current worldwide increase in poverty and inequalities—due to the consequences of the COVID-19 pandemic, and the effects of war in the Ukraine—could reverse progress made in the fight against HIV/AIDS in low- and middle-income countries (LMIC). Funding: National Institute of Allergy and Infectious Diseases (NAIDS), National Institutes of Health (NIH), US Grant Number: 1R01AI152938.http://www.sciencedirect.com/science/article/pii/S2667193X2300128XSocial determinants of healthAcquired immune deficiency syndromeSocioeconomic factorsPovertyEducational attainmentsEthnicity |
| spellingShingle | Iracema Lua Andrea F. Silva Nathalia S. Guimarães Laio Magno Julia Pescarini Rodrigo V.R. Anderle Maria Yury Ichihara Mauricio L. Barreto Carlos A.S. Teles Santos Louisa Chenciner Luis Eugênio Souza James Macinko Ines Dourado Davide Rasella The effects of social determinants of health on acquired immune deficiency syndrome in a low-income population of Brazil: a retrospective cohort study of 28.3 million individualsResearch in context The Lancet Regional Health. Americas Social determinants of health Acquired immune deficiency syndrome Socioeconomic factors Poverty Educational attainments Ethnicity |
| title | The effects of social determinants of health on acquired immune deficiency syndrome in a low-income population of Brazil: a retrospective cohort study of 28.3 million individualsResearch in context |
| title_full | The effects of social determinants of health on acquired immune deficiency syndrome in a low-income population of Brazil: a retrospective cohort study of 28.3 million individualsResearch in context |
| title_fullStr | The effects of social determinants of health on acquired immune deficiency syndrome in a low-income population of Brazil: a retrospective cohort study of 28.3 million individualsResearch in context |
| title_full_unstemmed | The effects of social determinants of health on acquired immune deficiency syndrome in a low-income population of Brazil: a retrospective cohort study of 28.3 million individualsResearch in context |
| title_short | The effects of social determinants of health on acquired immune deficiency syndrome in a low-income population of Brazil: a retrospective cohort study of 28.3 million individualsResearch in context |
| title_sort | effects of social determinants of health on acquired immune deficiency syndrome in a low income population of brazil a retrospective cohort study of 28 3 million individualsresearch in context |
| topic | Social determinants of health Acquired immune deficiency syndrome Socioeconomic factors Poverty Educational attainments Ethnicity |
| url | http://www.sciencedirect.com/science/article/pii/S2667193X2300128X |
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