Poverty, Hunger, Education, and Residential Status Impact Survival in HIV |
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Authors: | James McMahon Christine Wanke Norma Terrin Sally Skinner and Tamsin Knox |
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Affiliation: | (1) Department of Medicine, Tufts Medical Center, Boston, MA 02111, USA;(2) Nutrition/Infection Unit, Department of Public Health and Community Medicine, Tufts University School of Medicine, Jaharis 276, 150 Harrison Avenue, Boston, MA 02111, USA;(3) Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA |
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Abstract: | Despite combination antiretroviral therapy (ART), HIV infected people have higher mortality than non-infected. Lower socioeconomic
status (SES) predicts higher mortality in many chronic illnesses but data in people with HIV is limited. We evaluated 878
HIV infected individuals followed from 1995 to 2005. Cox proportional hazards for all-cause mortality were estimated for SES
measures and other factors. Mixed effects analyses examined how SES impacts factors predicting death. The 200 who died were
older, had lower CD4 counts, and higher viral loads (VL). Age, transmission category, education, albumin, CD4 counts, VL,
hunger, and poverty predicted death in univariate analyses; age, CD4 counts, albumin, VL, and poverty in the multivariable
model. Mixed models showed associations between (1) CD4 counts with education and hunger; (2) albumin with education, homelessness,
and poverty; and (3) VL with education and hunger. SES contributes to mortality in HIV infected persons directly and indirectly,
and should be a target of health policy in this population. |
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