Rural AIDS diagnoses in Florida: changing demographics and factors associated with survival

J Rural Health. 2013 Jun;29(3):266-80. doi: 10.1111/j.1748-0361.2012.00449.x. Epub 2013 Jan 14.


Purpose: To compare demographic characteristics and predictors of survival of rural residents diagnosed with acquired immunodeficiency syndrome (AIDS) with those of urban residents.

Methods: Florida surveillance data for people diagnosed with AIDS during 1993-2007 were merged with 2000 Census data using ZIP code tabulation areas (ZCTAs). Rural status was classified based on the ZCTA's rural-urban commuting area classification. Survival rates were compared between rural and urban areas using survival curves and Cox proportional hazards models controlling for demographic, clinical, and area-level socioeconomic and health care access factors.

Findings: Of the 73,590 people diagnosed with AIDS, 1,991 (2.7%) resided in rural areas. People in the most recent rural cohorts were more likely than those in earlier cohorts to be female, non-Hispanic black, older, and have a reported transmission mode of heterosexual sex. There were no statistically significant differences in the 3-, 5-, or 10-year survival rates between rural and urban residents. Older age at the time of diagnosis, diagnosis during the 1993-1995 period, other/unknown transmission mode, and lower CD4 count/percent categories were associated with lower survival in both rural and urban areas. In urban areas only, being non-Hispanic black or Hispanic, being US born, more poverty, less community social support, and lower physician density were also associated with lower survival.

Conclusions: In rural Florida, the demographic characteristics of people diagnosed with AIDS have been changing, which may necessitate modifications in the delivery of AIDS-related services. Rural residents diagnosed with AIDS did not have a significant survival disadvantage relative to urban residents.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acquired Immunodeficiency Syndrome / diagnosis*
  • Acquired Immunodeficiency Syndrome / mortality*
  • Adult
  • Female
  • Florida / epidemiology
  • Health Services Accessibility
  • Humans
  • Male
  • Middle Aged
  • Population Surveillance
  • Proportional Hazards Models
  • Rural Health / statistics & numerical data*
  • Social Class
  • Survival Rate
  • Urban Population / statistics & numerical data
  • Young Adult