These findings are of concern given the high rates of HIV among patients with low socioeconomic status (SES), according to the study, led by Dr. William Cunningham, professor of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.
"It's among these groups that the infection is increasing most rapidly, even though there are better treatments available than we used to have," said Cunningham, also a professor of public health. "There's still reason for alarm because the groups that are most likely to get infected are less likely to get treatment and are dying at much higher rates. We need to look at improving care and find ways to help the low socioeconomic status population, and we would recommend more resources being put toward those groups."
The article is published in the November issue of the Journal of Health Care for the Poor and Underserved (JHCPU 16.4).
Prior research has shown that HIV-infected patients from a low socioeconomic background, as well as racial and ethnic minorities, receive fewer health services, including treatment with Highly Active Antiretroviral Therapy (HAART). The researchers examined whether these patients also had higher mortality rates than others. They studied 2,864 adults receiving HIV care, basing their work on independent variables such as wealth (i.e. net accumulated financial assets), annual income, educational attainment, employment status, race/ethnicity, medical insurance, and use of services and of medications at the beginning of the study . The patients in the low socioeconomic group had less than $50,000 in accumulated wealth and annual incomes below $25,000, did not have high school degrees, and were unemployed. The researchers focused on deaths between January 1996 and December 2000.
They found that by December 2000, 585 of the patients, or 20 percent of those in the study, had died--13 percent from HIV and 7 percent from non-HIV causes such as cardiovascular disease, liver failure and intravenous drug overdoses. Patients who had no accumulated financial assets had an 89 percent greater chance of dying than those with more wealth, and those with less than a high school education had a 53 percent greater risk of death. They found no significant differences in survival by race and ethnicity, and they also did not see an elevated risk among patients with low annual incomes after taking into account all other factors.
A partial explanation for the findings may be that patients with low SES tend to use HAART and ambulatory care services less relative to other patients, but had a higher use of emergency room services and hospital care, Cunningham said. They are also less likely to have private insurance and are either uninsured or covered by public insurance such as Medicaid and Medicare.
"So they have an unfavorable pattern of services use --they had more of the bad stuff and less of the good stuff," he said.
Other UCLA researchers in addition to Cunningham were Drs. Ron Hays, professor of general internal medicine and health services research ; Naihua Duan, professor of psychiatry and biobehavioral sciences; Ronald M. Andersen, professor of health services; Terry T. Nakazono, research associate; Martin F. Shapiro, professor and chief of general internal medicine and health services research all with the David Geffen School of Medicine at UCLA; and Samuel A. Bozzette of the RAND Corp. and the VA Medical Center at the University of California, San Diego.
The RAND Corp.; the Agency for Health Research and Quality; the Health Resources and Services Administration; the National Institute of Mental Health; the National Institute on Drug Abuse; the National Institutes of Health Office of Research on Minority Health, through the National Institute of Dental Health; Merck and Co Inc.; Glaxo-Wellcome Inc.; the National Institutes on Aging; the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services; the National Institute of Health; the UCLA-Drew Project Export; the National Center for Minority Health and Health Disparities; the UCLA Center for Health Improvement in Minority Elders/Resource Centers for Minority Aging Research; and the Robert Wood Johnson Foundation, funded the study.