Epidemiol Health.  2018;40:e2018038. 10.4178/epih.e2018038.

Spatial inequalities and predictors of HIV/AIDS mortality risk in Hamadan, Iran: a retrospective cohort study

• Momenyan S
• Kavousi A
• Poorolajal J
• Momenyan N

• KMID: 2438492
• DOI: http://doi.org/10.4178/epih.e2018038

Abstract

OBJECTIVES
Understanding the geographic variation of HIV/AIDS mortality risk and human immunodeficiency virus (HIV) infection could help identify high-burden areas. The aim of our study was to evaluate the effects of predictors of the time interval between HIV diagnosis to death, while accounting for spatial correlations across counties, and to assess patterns of spatial inequalities in the risk of HIV/AIDS mortality in Hamadan Province, Iran.
METHODS
This retrospective study was conducted on 585 patients. The outcome in this study was the time period between the date of HIV/AIDS diagnosis and the date of death. A Weibull regression model with spatial random effects was used.
RESULTS
According to multivariate analysis, there were significant associations between age, tuberculosis co-infection, and marital status and the risk of death. In terms of spatial inequalities, a cluster of counties was identified with a somewhat higher death hazard in the north, northwest, northeast, and central regions. Additionally, a cluster with a somewhat lower hazard was identified in the south, southwest, southeast, and west regions.
CONCLUSIONS
The spatial pattern of HIV/AIDS death risk could reflect inequalities in access to antiretroviral therapy and public health services. Our results underscore the importance of attention to vulnerable groups in urban areas.

Keyword

HIV/AIDS; Mortality; Survival analysis; Spatial correlation; Iran

MeSH Terms

Cohort Studies*
Coinfection
Diagnosis
HIV
Humans
Iran*
Marital Status
Mortality*
Multivariate Analysis
Public Health
Retrospective Studies*
Socioeconomic Factors*
Survival Analysis
Tuberculosis