Low-Income HIV-Positive People More Likely to Die Than Counterparts With Higher Incomes, Study Says

Low-income HIV-positive people are more likely to die than HIV-positive people who have higher incomes and more education, according to a study published in the November issue of the Journal of Health Care for the Poor and Underserved, United Press International reports (United Press International, 11/1). Although treatment for HIV has improved, HIV-positive people with low socio-economic backgrounds have less access to health care services, including antiretroviral therapy. In addition, low-income individuals are more often infected with the virus. To determine whether these patients had higher mortality rates than others, William Cunningham of the University of California-Los Angeles David Geffen School of Medicine and colleagues examined 2,864 adults receiving HIV care and looked at their wealth, annual income, education level, employment status, race, ethnicity, medical insurance, and use of services and medication at the beginning of the study. Patients in the low socio-economic group had less than $50,000 in accumulated wealth and an annual income below $25,000, did not have a high school degree and were unemployed. Between January 1996 and December 2000, 585 -- or 20% -- of the patients died. Thirteen percent of them died of AIDS-related complications and 7% died of other causes, including cardiovascular disease, liver failure and injection drug overdoses. Patients who had no accumulated financial assets were 89% more likely to die than those with more wealth, and patients with less than a high school education were 53% more likely to die than those with at least a high school education, according to the study. The researchers found no significant difference in risk of death by race and ethnicity nor by annual income when other factors were taken into account.

Contributing Factors
Cunningham said low-income HIV-positive populations might have higher mortality rates because they use ambulatory care facilities more often and receive antiretroviral treatment less often than other patients. Low-income people also are less likely to have private health insurance and are either uninsured or covered by Medicaid or Medicare. "We need to look at improving care and find ways to help the low socio-economic status population, and we would recommend more resources being put toward those groups," Cunningham said (UCLA Health Sciences release, 10/31).

Kaiser Family Foundation Vice President Jackie Judd on Nov. 1 interviewed Cunningham regarding the study. The interview is available online.

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