Table 3.
Effect of social determinants of health on AIDS case-fatality rate over the study period 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).
| Model 1 |
Model 2 |
Model 3 |
Model 4 |
||||
|---|---|---|---|---|---|---|---|
| Intra-block analyses |
Inter-block analyses (Blocks 1 + 2) |
Inter-block analyses (Blocks 1 + 2 + 3) |
Inter-block analyses (Blocks 1 + 2+3 + 4) |
||||
| RR (95% CI) | RR (95% CI) | RR (95% CI) | RR (95% CI) | ||||
| Block 1—geographic factors | N = 18,583 | N = 15,674 | N = 14,085 | N = 11,815 | |||
| Region of residence | b | ||||||
| North | 1.00 | 1.00 | 1.00 | 1.00 | |||
| Northeast | 0.98 (0.85–1.15) | 1.00 (0.85–1.19) | 1.11 (0.93–1.34) | 0.96 (0.76–1.21) | |||
| Southeast | 0.97 (0.80–1.17) | 1.00 (0.80–1.25) | 1.16 (0.91–1.49) | 0.81 (0.64–1.03) | |||
| South | 0.86 (0.73–1.00) | 0.88 (0.73–1.06) | 1.02 (0.84–1.24) | 0.92 (0.71–1.18) | |||
| Mid-West | 0.98 (0.81–1.19) | 1.04 (0.84–1.29) | 1.13 (0.90–1.42) | 1.09 (0.82–1.45) | |||
| Area of residence | |||||||
| Rural | 1.00 | 1.00 | 1.00 | ||||
| Urbana | 0.96 (0.82–1.12) | 1.01 (0.85–1.20) | 1.14 (0.94–1.39) | – | |||
| Block 2—socioeconomic status | N = 15,836 | ||||||
| Education | a | a | a | a | |||
| Illiterate/never went to school | 2.65 (1.56–4.51) | 2.56 (1.48–4.40) | 2.30 (1.31–4.01) | 1.86 (1.02–3.41) | |||
| Literate/pre-school | 1.46 (0.68–3.15) | 1.41 (0.65–3.09) | 1.32 (0.61–2.88) | 1.23 (0.52–2.90) | |||
| Elementary school | 2.32 (1.39–3.86) | 2.25 (1.34–3.78) | 2.04 (1.19–3.50) | 1.73 (0.97–3.06) | |||
| High school | 1.76 (1.02–3.02) | 1.70a (0.98–2.93) | 1.49 (0.84–2.64) | 1.35 (0.75–2.42) | |||
| Higher education | 1.00 | 1.00 | 1.00 | 1.00 | |||
| Race/skin color | a | a | b | ||||
| White/Asian | 1.00 | 1.00 | 1.00 | 1.00 | |||
| Brown | 1.16 (1.06–1.27) | 1.10 (0.99–1.22) | 1.10 (0.99–1.22) | 1.09 (0.96–1.24) | |||
| Black | 1.24 (1.10–1.40) | 1.19 (1.05–1.33) | 1.16 (1.03–1.32) | 1.14 (1.01–1.30) | |||
| Indigenous | 0.68 (0.28–1.64) | 0.66 (0.27–1.59) | 0.74 (0.30–1.82) | 0.58 (0.22–1.55) | |||
| Wealth levels | |||||||
| Level 1 (Higher wealth) | 1.00 | 1.00 | 1.00 | 1.00 | |||
| Level 2 | 1.25 (1.03–1.51) | 1.25 (1.04–1.51) | 1.23a (1.00–1.53) | 1.18 (0.90–1.53) | |||
| Level 3 | 1.20 (0.91–1.57) | 1.20 (0.92–1.56) | 1.14 (0.86–1.52) | 1.07 (0.79–1.45) | |||
| Level 4 | 1.14 (0.93–1.39) | 1.16 (0.94–1.43) | 1.16 (0.91–1.47) | 1.01 (0.78–1.32) | |||
| Level 5 (Lower wealth) | 1.18 (0.95–1.48) | 1.22a (0.97–1.54) | 1.23 (0.95–1.61) | 1.09 (0.81–1.45) | |||
| Receipt time of Bolsa Família | a | a | a | a | |||
| Does not receive | 1.00 | 1.00 | 1.00 | 1.00 | |||
| Less than 2 years | 1.28 (1.08–1.52) | 1.29 (1.10–1.52) | 1.28 (1.08–1.53) | 1.23 (1.02–1.50) | |||
| Between 2 and 5 years | 1.13a (0.98–1.31) | 1.15 (1.01–1.32) | 1.11 (0.97–1.28) | 1.02 (0.87–1.21) | |||
| Between 5 and 10 years | 0.86 (0.74–0.99) | 0.87 (0.75–0.99) | 0.83 (0.71–0.96) | 0.77 (0.65–0.91) | |||
| More than 10 years | 0.69 (0.58–0.83) | 0.70 (0.581–0.84) | 0.66 (0.55–0.80) | 0.57 (0.46–0.72) | |||
| Block 3—household conditions | N = 16,856 | ||||||
| Household material | |||||||
| Brick | – | – | – | – | |||
| Wood | – | – | – | – | |||
| Mud and others | – | – | – | – | |||
| Electrical power | |||||||
| Yes | 1.00 | 1.00 | |||||
| No | 1.16 (1.02–1.31) | – | 1.13 (1.01–1.27) | – | |||
| Household density (residents/room) | |||||||
| Up to 2 | 1.00 | 1.00 | 1.00 | ||||
| More than 2 | 1.21 (1.05–1.40) | – | 1.23 (1.05–1.43) | 1.35 (1.12–1.63) | |||
| Water supply | |||||||
| Public network | – | – | – | – | |||
| Others | – | – | – | – | |||
| Waste disposal | |||||||
| Public collection | – | – | – | – | |||
| Not collected | – | – | – | – | |||
| Sewage system | b | a | a | ||||
| Sewage network | 1.00 | 1.00 | 1.00 | ||||
| Septic tank | 1.07 (0.94–1.23) | – | 1.10 (0.96–1.26) | 1.05 (0.89–1.24) | |||
| Others | 1.13 (1.02–1.25) | – | 1.14 (1.02–1.28) | 1.17 (1.03–1.33) | |||
| Block 4—health and behavioral aspects | N = 15,785 | ||||||
| Treatment | |||||||
| Yes | 1.00 | 1.00 | |||||
| No | 2.50 (2.13–2.92) | – | – | 2.58 (2.22–3.00) | |||
| Exposure category | a | a | |||||
| Homosexual | 1.00 | – | – | 1.00 | |||
| Bisexual | 1.10 (0.86–1.40) | – | – | 1.06 (0.79–1.43) | |||
| Heterosexual | 1.67 (1.40–1.98) | 1.56 (1.29–1.90) | |||||
| People who inject drugs | 2.98 (2.38–3.72) | – | – | 3.05 (2.36–3.94) | |||
| Model analysis | Block 1 | Block 2 | Block 3 | Block 4 | |||
| Mean VIF | 3.62 | 3.96 | 2.24 | 3.70 | 4.54 | 4.40 | 4.04 |
| Deviance goodness-of-fit (p-value) | ≤0.001 | ≤0.001 | ≤0.001 | ≤0.001 | ≤0.001 | ≤0.001 | ≤0.001 |
Abbreviations: CI: confidence interval; RR: rate ratio.
“-” variable not included in the model.
a
Overall p-value ≤0.05.
b
Overall p-value ≤0.10.