A proposal of measures for monitoring social disparities in health using AIDS and liver disease mortality before and after HAART

Abstract

Background: To assess the more appropriate measures for monitoring health differences and evaluating the impact of interventions based on the real burden of the health problem in the population and on the best alternative for communication with policymakers and with society at large. Methods: Disparity in mortality from acquired immunodeficiency syndrome (AIDS) and liver disease were measured in two cohorts of Spanish men: before and after the introduction of highly active antiretroviral therapy (HAART). Men were grouped into managers/professionals/technicians, clerks/service workers/manual workers and unemployed. The mortality rate difference and the mortality rate ratio in clerks/service workers/manual workers and in unemployed vs. managers/ professionals/technicians were estimated. Moreover, various summary measures of absolute disparity were also calculated. Results: Between the first and second period, the AIDS mortality rate difference decreased from 21.9 to 5.9 per 100000 person-years in clerks/service workers/manual workers and from 117.2 to 59.3 in unemployed, whereas the liver mortality rate difference increased from 4.7 to 6.4 and from 37.4 to 48.9, respectively. The AIDS mortality rate ratio increased by 11% in clerks/service workers/manual workers and by 50 in unemployed, while the liver disease mortality rate ratio increased by almost 400 in both groups. The summary measures of disparity decreased in AIDS mortality and increased in liver disease, although the magnitude of the change varied from one measure to another. Conclusions: The findings in unemployed men were the most important from the public health perspective; however, they could not be adequately identified with either mortality rate ratios or summary measures of absolute disparity. © 2010 The Author. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.