评估基于临床的干预措施,以减少美国人类免疫缺陷病毒患者死亡率的种族差异
Lauren C Zalla1, Stephen R Cole2, Joseph J Eron3
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
The Journal of infectious diseases
|July 12, 2023
概括
有针对性的临床干预可以显著减少黑人和白人成年人之间的人类免疫缺陷病毒 (HIV) 死亡率差距. 针对黑人患者的专注护理在缩小这种差距方面表现最有前途.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 临床医学 临床医学
背景情况:
- 在美国,黑人成年人死亡率不成比例地高于接受人类免疫缺陷病毒 (HIV) 护理的白人成年人.
- 在艾滋病毒护理的背景下,这些人口群体之间存在着严重的死亡率差异.
研究的目的:
- 评估基于诊所的假设干预措施对接受艾滋病毒治疗的成年人中黑人-白人死亡率差距的影响.
- 通过具体的干预策略量化潜在的死亡率差异减少.
主要方法:
- 分析了1996年至2019年期间超过4万名黑人和3万名白人成年人进入艾滋病毒治疗的3年死亡数据.
- 使用逆概率权衡来模拟假设干预,包括立即治疗和基于指南的后续治疗.
- 根据"通用"干预交付 (所有患者) 和"专注"交付 (仅限黑人患者) 的结果进行比较.
主要成果:
- 观察到的3年死亡率为黑人患者的9%,白人患者的8%,差异为1个百分点.
- 全民立即治疗将差距降至0.5%,并与基于指南的随访相结合,降至0.2%.
- 针对黑人患者的集中干预将黑人-白人死亡率差异降至-1.4%.
结论:
- 基于临床的干预措施,特别是针对黑人患者的干预措施,表明有可能显著缩小死亡率差距.
- 加强对黑人患者的护理是减少与艾滋病毒有关的死亡率差异的关键策略.
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