Students: Nicole Jones and Maria Victoria Saumell
Date: July 25th, 2011
Course: PHC6000 – Epidemiology
Case Study: HIV/AIDS
We have not plagiarized on any aspect of this assignment.
Executive Summary
HIV remains a concern in the United States, the state of Florida, and in Orange County,
Florida even though there has been many strategies implemented to reduce the effects of this
disease. Florida has a high incidence of HIV compared to other national states. Although there
has been no cure found for HIV, infected individuals are living longer due to advancements
made in treatment options and early detection campaigns. This is evident through the analysis of
HIV mortality rate trends from 1987-2007.
Variations and trends in HIV mortality rates are analyzed at the national, state, and local
levels in order to compare the differences between them. The visible differences can then be
examined to determine possible causes of variations. Previous studies have indicated a decline
in HIV mortality rates in the mid-1990s due to the introduction of highly active antiretroviral
treatment. A few years after the introduction, HIV mortality rates have plateaued even with the
discovery of numerous other antiretroviral prescription drugs (The National Bureau of Economic
Research, n.d.). Since its introduction, availability of antiretroviral treatment has also increased
due to the cost reduction of prescription treatment.
The percent changes in HIV mortality rates can be calculated with the death rates and
population numbers at each level. These statistics are useful to political leaders and public health
officials in order to prepare strategies and funding for the future. Since infected individuals are
living longer, the number of people on highly antiretroviral treatment is increasing. As a result,
costs for HIV-related support, including prescription drugs and healthcare costs from associated
illnesses, that are funded by the government will increase as well. It is imperative to determine
causes of increases or decreases of HIV mortality rates.
Through this case study, HIV mortality rates at the national, state, and local level will be
analyzed. The resulting peaks and dips in HIV mortality trends will need to be investigated to
determine possible causes.
Case Study: Variation and Trends in HIV mortality rates in Orange County, Florida; the state of
Florida; and the United States.
Description
Even though, currently, HIV is not one of the leading causes of death among Americans,
mortality rates are still significant (Deaths: Final Data for 2007, 2010). The HIV epidemic
continues to be a burden and must remain a priority for leadership since HIV and its related
illnesses can cause increased healthcare costs.
In this study, the purpose is to analyze the HIV mortality rates in the United States,
Florida as well as Orange County, Florida. The underlying issue needing analysis is the causes
of the variations of HIV mortality rates from the period of 1987 to 2007.
Table 1 shows HIV mortality rates compiled from 1987 to 2007 by the National Center
for Health Statistics for the United States. This data was obtained from death certificates of male
and female Americans from the fifty US states (CDC, 2007). In addition, Florida death rates
obtained from the Florida Department of Health, from 1995 to 2007, are shown.
Table 1. HIV mortality rates in the U.S. and Florida (per 100,000)
Location
US
Florida
1987
1990
1995
1996
1997
1998
1999
2000
2005
2006 2007
5.6
10.2
16.2
11.5
6.0
4.9
5.3
5.2
4.2
4.0
3.7
-
-
33.5
23.9
14.5
10.1
10.5
11.3
9.5
9.5
8.1
Source: Table adapted from Centers for Disease Control and Prevention (2010). Health, United
States: With Special Feature on Death and Dying. Retrieved July 20, 2011 from:
http://www.cdc.gov/nchs/data/hus/hus10.pdf#035 and Florida Department of Health (2011). HIV
Incidence, Prevalence, and Mortality. Epidemic Snapshot, Florida. Retrieved July 21, 2011 from:
http://www.doh.state.fl.us/disease_ctrl/aids/Docs/HIV_Epidemic_Snapshot_FL_2010.pdf
In 1997, HIV was one of the 15 leading causes of death (Deaths: Final Data for 2007,
2010). The significant reduction in mortality rates observed in 1996 and 1997 was mainly due to
the introduction of the Highly Active Antiretroviral Therapy, referred to as HAART (CDC,
2007). Another reason for this decline is the reduction in the HIV incidence after the 1980s,
having an impact in the number of HIV deaths countrywide and in Florida (The HIV/AIDS
Epidemic in the United States, 2011). Additionally, prevention strategies and the development of
new prophylactic drugs for opportunistic infections have contributed to the reduction in mortality
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rates (CDC, 2007). The trend is also evident in Florida, where mortality rates declined noticeably
in 1996 and 1997 with leveling rates beginning in 1998 (Florida Annual Report 2007:
AIDS/HIV, 2007). Experts suggest possible reasons for this include resistance to the virus, late
diagnosis, lack of adherence to treatment and deficient access to medical care (Florida Annual
Report 2007: AIDS/HIV, 2007).
Death rates in Florida are higher than the average rates for the United States. In fact,
Florida ranked third in AIDS diagnosis rate and cumulative AIDS diagnosis through 2009 (The
HIV/AIDS Epidemic in the United States, 2011). Table 2 shows mortality rates for the Counties
of Orange, Osceola and Seminole determined from 2002 to 2009. The purpose of this table is to
facilitate a comparative analysis across geographic regions and over time.
Table 2. Central Florida HIV mortality rates (per 100,000)
County
2002
2003
2004
2005
2006
2007
2008
2009
Orange
10.0
12.8
12.2
10.2
9.1
7.9
8.5
0.6
Osceola
4.6
7.5
6.4
2.6
3.6
4.8
5.5
0.4
Seminole
4.7
4.7
4.4
4.8
3.3
3.7
3.7
0.2
In Central Florida, the Orange County has the highest mortality rates for all the periods
shown in Table 2. According to the HIV/AIDS Florida Annual Report from the Florida
Department of Health (2007), the majority of AIDS cases in 2007 were reported from the
following counties: Broward, Duval, Hillsborough, Miami-Dade, Orange, Palm Beach, and
Pinellas, making up the 72 percent of HIV cases in Florida (Florida Annual Report 2007:
AIDS/HIV, 2007). Accordingly, the highest AIDS incidence was reported from Orange,
Broward and Miami-Dade Counties and the three reported the 46 percent of the total Florida
cases (Florida Annual Report 2007: AIDS/HIV, 2007).
Data for 2009 shows a significant decline in deaths for Orange, Osceola and Seminole
County. Talk here about prevention efforts in Florida, new strategies and more outreach of
interventions.
According to Fleming, mortality rates can be compared across time, geographic areas or
population groups (Fleming, 2008, p. 129). A useful method to compare rates over time is
obtaining the growth/decline rate or percent change. Percent Change can be calculated as
follows: % change = (rate end year – rate beginning year)/rate beginning year x 100
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(Wassertheil-Smoller, S., 2004, p. 91). As a result of this analysis, rates can be interpreted and
trends or patterns can be estimated (Fleming, 2008, p. 130). Mortality rates can also be tracked
across geographic areas with the purpose of comparing two or more different cities, counties,
states or countries (Fleming, 2008, p. 131). Tables 1 and 2 in this case study show trends across
geographic areas and over time.
Questions
1. Using the information provided in Table 1, calculate the percent change (growth or
decline) in HIV mortality rates consecutively, from 1987 to 2007, for the United States,
Florida, and Orange County, Florida. The percent change should reflect growth or
reduction in rates from 1987 to 1990, 1990 to 1995, 1995 to 1996, and so on. How do
Florida rates compare to US rates?
2. Observe the mortality rates in Table 1. Identify the main trends including high points, low
points and other significant findings. What are the main causes of the significant decrease
in mortality rates during the mid 1990s? Are there other public health/social trends
affecting the change of the rates from 1987 to 2007?
3. Review mortality rates for Orange County, Florida. What are the main differences across
Orange County in terms of HIV mortality rates? How do these compare to the Florida
and United States mortality rates?
Answers
1. Percentage change: (rate end year – rate beginning year)/rate beginning year x 100
Percent change in US and Florida mortality rates over time (See excel file attached)
Location
US rates
Percent
change US
FL rates
Percent
change FL
1987
1990
1995
1996
1997
1998
1999
2000
2005
2006
2007
5.6
10.2
16.2
11.5
6.0
4.9
5.3
5.2
4.2
4.0
3.7
-
82.1
58.8
-29.0
-47.8
-18.3
8.2
-1.9
-19.2
-4.8
-7.5
-
-
33.5
23.9
14.5
10.1
10.5
11.3
9.5
9.5
8.1
-
-
-
-28.7
-39.3
-30.3
4.0
7.6
-15.9
0.0
-14.7
2. In the U.S. the peak of the epidemic was in 1995 (16.2 per 100.000). The same trend was
evident in Florida with 33.5 HIV deaths per 100,000. The lowest point was in 2007 with
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a rate of 3.7 per 100,000 countrywide and 8.1 per 100,000 in Florida. The introduction of
the HAART was the main cause of the reduction in mortality rates from 1995 to 1996 and
1997. In addition, prevention efforts and the development of new prophylactic drugs for
opportunistic infections contributed to the reduction of HIV mortality rates in the United
States. Eve though, the reduction in mortality has been significant since the introduction
of HAART, a leveling trend beginning in 1998 shows that further improvements are
required in terms of access to care, adherence to treatment and preventive strategies.
3. Orange County, Florida, shows the highest HIV mortality rates for all periods assessed.
Teaching Notes
The Florida Department of Health was used as a source of HIV statistics. However, for
some specific periods of time, information was not available. Those cells in Table 1 that do not
have information is due to the unavailability of statistical data for the year.
Appendix: Benefits and Synergy of the team
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Gathering information and discussing ideas in the discussion board
-
Exchanged ideas, all revolving around HIV/AIDS statistics
-
Entirely online, no face-to-face meetings.
-
Communication: phone , wiki and discussion boards.
-
The team was advised by Dr. Driscoll that it was suggested to focus on Central Florida
statistics
-
Vicky focused on mortality rates, constructing and adapting tables and gathering
statistical information in Florida.
-
Nicole did the Executive Summary and also worked on the description of the case.
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References
Centers for Disease Control and Prevention (2007).Mortality Slides Series [PowerPoint slides].
Retrieved July 15th, from:
http://www.cdc.gov/hiv/topics/surveillance/resources/slides/trends/
Centers for Disease Control and Prevention (2010). Deaths: Final Data for 2007. Retrieved July
20, 2011 from: http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf
Centers for Disease Control and Prevention (2010). Health, United States: With Special Feature
on Death and Dying. Retrieved July 20, 2011 from:
http://www.cdc.gov/nchs/data/hus/hus10.pdf#035
Fleming, S. T. (2008). Managerial Epidemiology: Concepts and Cases. 2nd Edition. Chicago:
Health Administration Press.
Florida Department of Health (2007). Florida Annual Report 2007: AIDS/HIV. Retrieved July
22, 2011 from: http://www.doh.state.fl.us/disease_ctrl/aids/trends/epiprof/mini_aids07c.pdf
Florida Department of Health (2011). HIV Incidence, Prevalence, and Mortality. Epidemic
Snapshot, Florida. Retrieved July 21, 2011 from:
http://www.doh.state.fl.us/disease_ctrl/aids/Docs/HIV_Epidemic_Snapshot_FL_2010.pdf
Francis, D. R. (n.d.) New Drugs and HIV mortality. The National Bureau of Economic Research.
Retrieved July 22, 2011 from: http://www.nber.org/digest/apr05/w11109.html
Kaiser Family Foundation (2011). The HIV/AIDS Epidemic in the United States. Retrieved July
23, 2011 from: http://www.kff.org/hivaids/upload/3029-12.pdf
Wassertheil-Smoller, S. (2004). Biostatistics and epidemiology: a primer for health and
biomedical professionals, 3rd Edition. New York: Springer-Verlag.
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