Neighborhood Latino ethnic density and mortality among HIV-positive Latinos by birth country/region, Florida, 2005–2008

ABSTRACT

Objective. Lower mortality for Latinos has been reported in high Latino density areas. The objective was to examine the contribution of neighborhood Latino density to mortality among HIV-positive Latinos.

Methods. Florida HIV surveillance data for 2005–2008 were merged with the 2007–2011 American Community Survey data using zip code tabulation areas. Hazard ratios (HR) were calculated using multi-level weighted Cox regression and adjusted for individual-level factors and neighborhood poverty.

Results. Of 4649 HIV-positive Latinos, 11.8% died. There was no difference in mortality risk across categories of Latino ethnic density for Latinos as a whole. There were subgroup effects wherein mortality risk differed by ethnic density category for Latinos born in some countries/regions. Residing in an area with ≥50% Latinos compared with <25% was associated with increased mortality risk for Latinos born in Puerto Rico (HR 1.67; 95% confidence interval [CI] [1.01–2.70]). Residing in an area where Mexicans were the majority Latino group was associated with increased mortality risk for Latinos born in Mexico (HR 3.57; 95% CI [1.43–10.00]).

Conclusions. The survival advantage seen among the Latino population in high Latino density areas was not seen among HIV-positive Latinos. Research is needed to determine if this may be related to stigma or another mechanism.

KEYWORDS:

• Latino
• human immunodeficiency virus
• ethnic density
• mortality
• neighborhood

Acknowledgements

We especially would like to thank Dr Georg Heinz in the Section for Clinical Biometrics at the Medical University of Vienna for his guidance in using the weighted Cox regression macro as well as his generous support in adjusting the macro for our needs. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Minority Health and Health Disparities or the National Institutes of Health.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by National Institute on Minority Health & Health Disparities (NIMHD) Award P20MD002288 and 5R01MD004002.