Health disparities between blacks and whites with HIV/AIDS : an analysis of U.S. national health care surveys from 1996-2008
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Blacks are more affected by Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) than any other race or ethnicity in the United States. The purpose of this dissertation was to investigate potential race-based differences in cardiovascular disease (CVD)-related hospitalizations and use of opportunistic infection (OI) prophylaxis between Blacks and Whites with HIV/AIDS. This dissertation includes two systematic literature reviews that identified knowledge gaps in the areas of CVD diagnosis and OI prophylaxis use between Blacks and Whites with HIV/AIDS, as well as two independent studies that addressed some of the gaps identified in the literature. The first study evaluated the association between race and CVD-related hospitalization in Blacks and Whites with HIV/AIDS. Data were retrieved from the 1996-2008 National Hospital Discharge Surveys (NHDS). Approximately 1.5 million hospital discharges were identified. After controlling for confounders, the odds of CVD-related hospitalization were 45% higher for Blacks than Whites (OR=1.45, 95% CI, 1.39-1.51). There was a statistically significant difference in the proportions of CVD-related hospitalization type and race (x2=479.77; df=3; p<0.001). Compared to Whites with HIV/AIDS, Blacks with HIV/AIDS had greater proportions of heart failure and hypertension, but lower proportions of stroke and coronary heart disease. These results suggest that there is an influence of race on both the occurrence and type of CVD-related hospitalizations in patients with HIV/AIDS. The second study assessed if race was associated with the use of OI prophylaxis (Pneumocystis jiroveci pneumonia [PCP] and Mycobacterium avium complex [MAC]). Data for this study were retrieved from the 1996-2008 National Hospital Ambulatory Medical Care Surveys (NHAMCS). Approximately 9.1 million hospital ambulatory visits were identified. After controlling for confounders, the odds of PCP prophylaxis use were 16% higher for Blacks than for Whites (OR=1.16, 95% CI, 1.15-1.17). In a separate regression analysis, the odds of MAC prophylaxis use were 12% higher for Blacks than for Whites (OR=1.12, 95% CI, 1.10-1.13). These findings suggest that Blacks with HIV/AIDS may have increased odds for OI prophylaxis. Based on this work, there is a need for further research to confirm these findings and to identify the causes of these race-based disparities.