Table 2.
Effect of social determinants of health on AIDS incidence and mortality rates in Brazil, results of Hierarchy Analysis using multivariable Poisson Regression adjusted for gender, age, year of admission to the cohort and municipal HIV/AIDS endemicity and mortality in the period (2007–2015).
| AIDS incidence rate |
AIDS mortality rate |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Model 1 |
Model 2 |
Model 3 |
Model 1 |
Model 2 |
Model 3 |
|||||
| Intra-block analyses |
Inter-block analyses (Blocks 1 + 2) |
Inter-block analyses (Blocks 1 + 2 + 3) |
Intra-block analyses |
Inter-block analyses (Blocks 1 + 2) |
Inter-block analyses (Blocks 1 + 2 + 3) |
|||||
| RR (95% CI) | RR (95% CI) | RR (95% CI) | RR (95% CI) | RR (95% CI) | RR (95% CI) | |||||
| Block 1—geographic factors | N = 28,219,514 | N = 24,673,018 | N = 22,468,882 | N = 28,219,545 | N = 24,673,044 | N = 22,468,903 | ||||
| Region of residence | a | a | a | a | a | a | ||||
| North | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Northeast | 1.09 (0.99–1.20) | 1.10 (1.00–1.20) | 1.22 (1.11–1.35) | 0.98 (0.89–1.08) | 0.98 (0.89–1.09) | 1.16 (1.03–1.31) | ||||
| Southeast | 1.09 (0.99–1.20) | 1.13 (1.03–1.23) | 1.26 (1.15–1.39) | 1.20 (1.04–1.39) | 1.23 (1.05–1.45) | 1.46 (1.20–1.78) | ||||
| South | 1.29 (1.17–1.43) | 1.41 (1.70–1.55) | 1.48 (1.35–1.63) | 1.16a (0.99–1.35) | 1.24 (1.04–1.47) | 1.36 (1.14–1.63) | ||||
| Mid-West | 1.15 (1.02–1.30) | 1.16 (1.03–1.32) | 1.28 (1.13–1.45) | 1.03 (0.91–1.16) | 1.06 (0.92–1.22) | 1.21 (1.03–1.42) | ||||
| Area of residence | ||||||||||
| Rural | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Urbana | 1.93 (1.81–2.05) | 2.05 (1.92–2.20) | 2.17 (2.02–2.33) | 2.03 (1.84–2.24) | 2.17 (1.96–2.40) | 2.35 (2.11–2.62) | ||||
| Block 2—socioeconomic status | N = 24,706,061 | N = 24,710,440 | ||||||||
| Education | a | a | a | a | a | a | ||||
| Illiterate/never went to school | 1.38 (1.19–1.60) | 1.51 (1.31–1.73) | 1.46 (1.26–1.68) | 2.67 (1.97–3.63) | 2.93 (2.14–4.02) | 2.76 (1.99–3.82) | ||||
| Literate/pre-school | 1.04 (0.84–1.29) | 1.12 (0.91–1.38) | 1.10 (0.89–1.36) | 1.48 (1.00–2.21) | 1.59 (1.06–2.40) | 1.46 (0.95–2.25) | ||||
| Elementary school | 1.41 (1.22–1.62) | 1.45 (1.27–1.65) | 1.43 (1.25–1.65) | 2.55 (1.90–3.44) | 2.58 (1.92–3.48) | 2.50 (1.83–3.41) | ||||
| High school | 0.95 (0.84–1.07) | 0.96 (0.85–1.08) | 0.97 (0.85–1.09) | 1.30 (0.94–1.78) | 1.28 (0.93–1.75) | 1.23 (0.88–1.71) | ||||
| Higher education | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Race/skin color | a | a | a | a | a | a | ||||
| White/Asian | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Brown | 1.09 (1.04–1.14) | 1.17 (1.12–1.23) | 1.17 (1.12–1.22) | 1.12 (1.05–1.20) | 1.20 (1.12–1.28) | 1.19 (1.12–1.27) | ||||
| Black | 1.51 (1.42–1.60) | 1.56 (1.48–1.65) | 1.53 (1.45–1.61) | 1.73 (1.57–1.90) | 1.75 (1.62–1.89) | 1.69 (1.57–1.83) | ||||
| Indigenous | 0.81 (0.64–1.04) | 1.16 (0.91–1.46) | 1.12 (0.87–1.43) | 0.87 (0.61–1.25) | 1.25 (0.87–1.80) | 1.20 (0.82–1.75) | ||||
| Wealth levels | a | a | a | a | a | a | ||||
| Level 1 (Higher wealth) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Level 2 | 1.08 (1.01–1.14) | 1.09 (1.03–1.16) | 1.07 (1.01–1.14) | 1.20 (1.08–1.34) | 1.23 (1.10–1.37) | 1.17 (1.04–1.32) | ||||
| Level 3 | 1.24 (1.14–1.34) | 1.29 (1.20–1.39) | 1.27 (1.17–1.37) | 1.40 (1.20–1.63) | 1.48 (1.29–1.71) | 1.42 (1.21–1.66) | ||||
| Level 4 | 1.34 (1.23–1.47) | 1.37 (1.27–1.48) | 1.32 (1.23–1.43) | 1.60 (1.40–1.82) | 1.66 (1.47–1.88) | 1.58 (1.36–1.82) | ||||
| Level 5 (Lower wealth) | 1.56 (1.41–1.72) | 1.60 (1.48–1.73) | 1.55 (1.43–1.68) | 1.94 (1.68–2.25) | 2.08 (1.81–2.40) | 1.99 (1.70–2.34) | ||||
| Receipt time of Bolsa Famíliaa | a | a | a | a | a | |||||
| Does not receive | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Less than 2 years | 1.11 (1.05–1.18) | 1.11 (1.05–1.17) | 1.08 (1.03–1.14) | 1.23 (1.14–1.32) | 1.22 (1.13–1.31) | 1.18 (1.08–1.29) | ||||
| Between 2 and 5 years | 1.04 (0.99–1.09) | 1.05a (1.00–1.11) | 1.05a (1.00–1.10) | 1.05 (0.96–1.15) | 1.06 (0.97–1.15) | 1.05 (0.96–1.14) | ||||
| Between 5 and 10 years | 0.83 (0.79–0.88) | 0.87 (0.83–0.92) | 0.86 (0.81–0.91) | 0.64 (0.60–0.69) | 0.68 (0.63–0.73) | 0.66 (0.61–0.72) | ||||
| More than 10 years | 0.67 (0.62–0.72) | 0.72 (0.68–0.77) | 0.70 (0.65–0.75) | 0.44 (0.40–0.49) | 0.49 (0.44–0.54) | 0.47 (0.42–0.52) | ||||
| Block 3—household conditions | N = 25,267,933 | N = 25,267,958 | ||||||||
| Household material | a | a | a | a | ||||||
| Brick | 1.00 | 1.00 | 1.00 | 1.00 | ||||||
| Wood | 1.23 (1.16–1.29) | – | 1.21 (1.15–1.28) | 1.27 (1.16–1.38) | – | 1.31 (1.19–1.43) | ||||
| Mud and others | 1.11 (1.04–1.18) | – | 1.07 (1.00–1.14) | 1.04 (0.94–1.15) | – | 1.10 (0.99–1.21) | ||||
| Electrical power | ||||||||||
| Yes | 1.00 | 1.00 | 1.00 | 1.00 | ||||||
| No | 1.19 (1.13–1.25) | – | 1.15 (1.09–1.21) | 1.31 (1.20–1.43) | – | 1.24 (1.16–1.33) | ||||
| Household density (residents/room) | ||||||||||
| Up to 2 | 1.00 | 1.00 | 1.00 | 1.00 | ||||||
| More than 2 | 1.15 (1.07–1.23) | – | 1.15 (1.09–1.22) | 1.23 (1.13–1.35) | – | 1.23 (1.12–1.35) | ||||
| Water supply | ||||||||||
| Public network | 1.00 | 1.00 | ||||||||
| Others | 0.92 (0.87–0.97) | – | – | 0.97 (0.90–1.06) | – | – | ||||
| Waste disposal | ||||||||||
| Public collection | 1.00 | 1.00 | ||||||||
| Not collected | 0.63 (0.59–0.67) | – | – | 0.60 (0.54–0.67) | – | – | ||||
| Sewage system | a | a | ||||||||
| Sewage network | 1.00 | 1.00 | ||||||||
| Septic tank | 0.95 (0.90–1.00) | – | – | 0.89 (0.81–0.97) | – | – | ||||
| Others | 0.93 (0.89–0.97) | – | 0.87 (0.81–0.94) | – | – | |||||
| Model analysis | Block 1 | Block 2 | Block 3 | Block 1 | Block 2 | Block 3 | ||||
| Mean VIF | 2.14 | 2.78 | 1.63 | 3.09 | 3.07 | 2.12 | 2.77 | 1.62 | 3.07 | 3.06 |
| Deviance goodness-of-fit (p-value) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Abbreviations: CI: confidence interval; RR: rate ratios.
“-” variable not included in the model.
a
Overall p-value ≤0.05.