Author | Lua, Iracema | |
Author | Silva, Andrea F. | |
Author | Guimarães, Nathalia S. | |
Author | Magno, Laio | |
Author | Pescarini, Julia | |
Author | Anderle, Rodrigo V. R. | |
Author | Ichihara, Maria Yury | |
Author | Barreto, Mauricio L. | |
Author | Santos, Carlos A. S. Teles | |
Author | Chenciner, Louisa | |
Author | Souza, Luis Eugênio | |
Author | Macinko, James | |
Author | Dourado, Ines | |
Author | Rasella, Davide | |
Access date | 2024-02-08T17:48:21Z | |
Available date | 2024-02-08T17:48:21Z | |
Document date | 2023 | |
Citation | LUA, Iracema et al. 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 individuals. The Lancet Regional Health – Americas, v. 24, p. 1-15, 2023. | en_US |
ISSN | 2667-193X | en_US |
URI | https://www.arca.fiocruz.br/handle/icict/62614 | |
Sponsorship | National Institute of Allergy and Infectious Diseases (NAIDS).
National Institutes of Health (NIH). | en_US |
Language | eng | en_US |
Publisher | Elsevier | en_US |
Rights | open access | en_US |
Subject in Portuguese | Síndrome da Imuno-deficiência adquirida | en_US |
Subject in Portuguese | Conquistas educacionais | en_US |
Subject in Portuguese | Etnia | en_US |
Subject in Portuguese | Pobreza | en_US |
Subject in Portuguese | Determinantes sociais da saúde | en_US |
Subject in Portuguese | Fatores socioeconômicos | en_US |
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 individuals | en_US |
Type | Article | en_US |
DOI | 10. 1016/j.lana.2023. 100554 | |
Abstract | 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). | en_US |
Affilliation | Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil / Universidade Estadual de Feira de Santana. Departamento de Saúde. Feira de Santana, BA, Brasil. | en_US |
Affilliation | Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimento para Saúde. Salvador, BA, Brasil. | en_US |
Affilliation | Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil. | en_US |
Affilliation | Universidade Estadual da Bahia. Departamento de Ciências da Vida. Salvador, BA, Brasil. | en_US |
Affilliation | Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimento para Saúde. Salvador, BA, Brasil / Faculty of Epidemiology and Population Health. London School of Hygiene & Tropical Medicine. London, UK. | en_US |
Affilliation | Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil. | en_US |
Affilliation | Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimento para Saúde. Salvador, BA, Brasil. | en_US |
Affilliation | Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimento para Saúde. Salvador, BA, Brasil. | en_US |
Affilliation | Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimento para Saúde. Salvador, BA, Brasil. | en_US |
Affilliation | Nuffield 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, UK. | en_US |
Affilliation | Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil. | en_US |
Affilliation | Departments of Health Policy and Management and Community Health Sciences. UCLA Fielding School of Public Health. Los Angeles, California, USA. | en_US |
Affilliation | Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil. | en_US |
Affilliation | Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil / ISGlobal. Hospital Clinic - Universitat de Barcelona. Barcelona, Spain. | en_US |
Subject | Acquired immune deficiency syndrome | en_US |
Subject | Educational attainments | en_US |
Subject | Ethnicity | en_US |
Subject | Poverty | en_US |
Subject | Social determinants of health | en_US |
Subject | Socioeconomic factors | en_US |
DeCS | Síndrome de Imunodeficiência Adquirida | en_US |
DeCS | Educação | en_US |
DeCS | Etnicidade | en_US |
DeCS | Pobreza | en_US |
DeCS | Determinantes Sociais da Saúde | en_US |
DeCS | Fatores socioeconômicos | en_US |