Examining geographic and temporal variations of AIDS mortality: evidence of racial disparities

BACKGROUND: There is little literature on spatiotemporal trends of AIDS mortality among different race and gender groups. The purpose of the present study is to describe AIDS mortality geographically and temporally, and to determine if detected trends vary by race and gender. METHODS: The Spatial Scan Statistic was employed to examine the geographic excess of AIDS mortality by race and gender in 24 Maryland jurisdictions between 1987 and 2003. Spatial analysis was conducted to identify clusters of excess mortality. The temporal scan statistic was used to explore time trends of AIDS mortality. Prospective space-time analysis was also conducted to verify if detected clusters persisted into the present. RESULTS: Among 10,887 AIDS deaths, 77.5% occurred in African Americans. Geographic excesses of AIDS mortality were detected in Baltimore city, and Howard, Montgomery, Anne Arundel, Prince Georges and Baltimore counties. Over the study period, AIDS mortality peaked in 1995 and then sharply dropped until 1998, when it stabilized. However, the AIDS mortality of African-American women started oscillating upward in 1998. CONCLUSION: This study quantitatively described geographic and temporal variations of AIDS mortality in Maryland by gender and racial groups. The results may inform development of programs to address HIV/AIDS while considering the groups most affected differentially by geographic area.