This place is killing me: A comparison of counties where the incidence rates of AIDS increased the most and least

Background. The objective of this study was to identify the socioeconomic and health characteristics of communities with the largest proportional increases in incidence rates of acquired immunodeficiency syndrome (AIDS). Methods. Reported AIDS cases (1981–1990 and 1995–1999) were used for a comparison between 20 US counties with the largest proportional increases in incidence rates of AIDS and 20 US counties with the smallest increases. Data were obtained from Community Health Status Indicators Reports of the Health Resources and Services Administration (HRSA) and from the US Census Bureau. Results. Counties with the largest increases in the incidence of AIDS had lower levels of income, education, and literacy; higher incidence rates of syphilis, age-adjusted mortality (all causes), and infant mortality; more low-birth-weight infants; and higher levels on all 9 specific mortality measures in the HRSA reports. Conclusions. The incidence of AIDS increased the most in areas where many other health problems occurred. Research is needed to identify and address the root causes of ill health. Many of the important gains in health over the previous 3 centuries have been attributed to behavioral and en-vironmental factors rather than to medical treatmen