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

Momenyan, Somayeh; Kavousi, Amir; Poorolajal, Jalal; Momenyan, Narges

doi:2018.0.0.e2018038

Original article

Epidemiology and Health 2018;e2018038.
DOI: https://doi.org/10.4178/epih.e2018038 [Accepted] Published online August 5, 2018.

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

¹Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
²Research Center for Health Sciences and Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
³Medical Informatics Department, Tarbiat Modares University, Tehran, Iran

Correspondence Amir Kavousi ,Tel: 02532910209, Fax: 8797777, Email: kavousi_am@yahoo.com

Received: May 17, 2018 Accepted after revision: August 5, 2018

Abstract

Objectives:
Understanding of the geographic variation of HIV/AIDS mortality risk and HIV infection could help identify high burden areas. The aim of our study was to evaluate the eﬀect of predictors on the time of HIV diagnosis to death whereas accounting the spatial correlations across the counties and to assess patterns of spatial inequalities in the risk of HIV/AIDS death in Hamadan province, Iran.
Method:
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. The Weibull regression model with spatial random effects was used.
Results:
According to multivariate analysis, there was a significant association between age, TB co-infection, and marital status with the risk of death. In the regard of spatial inequalities pattern, one cluster of counties was identified with somewhat higher death hazard in the north, northwest, northeast and central regions. Also one cluster with somewhat lower hazard was identified in south, southwest, southeast and west regions.
Conclusion:
Identifying the spatial pattern of HIV/AIDS death risk could reflect inequalities in access to antiretroviral therapy and public health services. Our results recommend the importance of attention to the vulnerable groups in the urban areas.

Keywords: HIV; AIDS; Mortality; Survival analysis; spatial correlation; Iran