Mary Jo Trepka1,2, Rahel Dawit1, Sofia B Fernandez2,3, Diana M Sheehan1,2,4, Abraham Degarege5, Tan Li6, Lorene M Maddox7, Emma C Spencer7. 1. Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. 2. Research Center in Minority Institutions, Florida International University, Miami, Florida, USA. 3. School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. 4. Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA. 5. Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, Nebraska, USA. 6. Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. 7. HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, Tallahassee, Florida, USA.
Abstract
PURPOSE: To compare the role of neighborhood social disorganization factors on human immunodeficiency virus (HIV) diagnosis rates in urban and rural areas in Florida, we conducted an ecologic study of HIV diagnosis rates during 2013-2017 and social disorganization components, including concentrated disadvantage, ethnic heterogeneity, and residential instability. METHODS: Indices of social disorganization components were obtained from principal component analyses of American Community Survey variables for 910 postal codes. Rural/urban classification was based on the United States Department of Agriculture Rural Urban Commuting Area codes. Using multivariable linear regression, the relationship between social disorganization indices and HIV diagnosis rates was assessed. FINDINGS: The only social disorganization index that was significantly higher in rural than urban areas was concentrated disadvantage. In rural areas, the concentrated disadvantage index was significantly associated with HIV diagnosis rates (P = .007) when controlling for the other social disorganization factors but was no longer significant after additionally controlling for prevalence of people with an HIV diagnosis who were not virally suppressed. In urban areas, even after controlling for prevalence of people with HIV who were not virally suppressed, lower male-to-female population ratios and higher scores of residential instability, concentrated disadvantage, and LatinX/immigrant density indices were associated with higher HIV diagnosis rates (all P < .01). CONCLUSIONS: In addition to improving community levels of viral suppression, the community contextual environment, including the rurality of the environment, needs to be considered in strategies to end the HIV epidemic in the United States.
PURPOSE: To compare the role of neighborhood social disorganization factors on human immunodeficiency virus (HIV) diagnosis rates in urban and rural areas in Florida, we conducted an ecologic study of HIV diagnosis rates during 2013-2017 and social disorganization components, including concentrated disadvantage, ethnic heterogeneity, and residential instability. METHODS: Indices of social disorganization components were obtained from principal component analyses of American Community Survey variables for 910 postal codes. Rural/urban classification was based on the United States Department of Agriculture Rural Urban Commuting Area codes. Using multivariable linear regression, the relationship between social disorganization indices and HIV diagnosis rates was assessed. FINDINGS: The only social disorganization index that was significantly higher in rural than urban areas was concentrated disadvantage. In rural areas, the concentrated disadvantage index was significantly associated with HIV diagnosis rates (P = .007) when controlling for the other social disorganization factors but was no longer significant after additionally controlling for prevalence of people with an HIV diagnosis who were not virally suppressed. In urban areas, even after controlling for prevalence of people with HIV who were not virally suppressed, lower male-to-female population ratios and higher scores of residential instability, concentrated disadvantage, and LatinX/immigrant density indices were associated with higher HIV diagnosis rates (all P < .01). CONCLUSIONS: In addition to improving community levels of viral suppression, the community contextual environment, including the rurality of the environment, needs to be considered in strategies to end the HIV epidemic in the United States.
Authors: Diana M Sheehan; Kristopher P Fennie; Daniel E Mauck; Lorene M Maddox; Spencer Lieb; Mary Jo Trepka Journal: AIDS Patient Care STDS Date: 2017-04 Impact factor: 5.078
Authors: Zihao Li; David W Purcell; Stephanie L Sansom; Demorah Hayes; H Irene Hall Journal: MMWR Morb Mortal Wkly Rep Date: 2019-03-22 Impact factor: 17.586
Authors: Max-Louis G Buot; Jeffrey P Docena; Brenda K Ratemo; Matthew J Bittner; Jacob T Burlew; Aziz R Nuritdinov; Jennifer R Robbins Journal: PLoS One Date: 2014-04-17 Impact factor: 3.240