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    Urban vs rural mortality due to HIV in the USA using the CDC WONDER database over 22 years: a retrospective study
    (Springer Heidelberg, 2025) Arora, Shiv; Kafali, Onuralp; Kaka, Manaswini Chowdary; Thin, Kyu Kyu; Rao, Nidhi Laxminarayan; Yerramalla, Sai Dinesh; Bakhle, Rahul
    IntroductionHIV remains a persistent epidemic in the USA. Although newer and more effective screening and treatment regimens have reduced mortality, a significant disparity exists in urban and rural areas. This study aims to identify disparities in mortality in urban and rural areas for HIV using the CDC-WONDER database from 1999 to 2020 and to analyze any significant differences in mortality rates as well as demographic variables.MethodologyThe Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiological Research (CDC WONDER) database was used to investigate the Rural and Urban Mortality trends for HIV, ICD-10 codes B20-B24, from 1999-2020. The extracted data was systematically grouped by 10-year age range, gender, census region, and race, and analyzed for trends and patterns over time using the R Studio v4.3.2. package to give a statistically significant result with clear representative figures.ResultsThe study showed that urban areas reported 194,717 deaths from HIV, whereas non-metropolitan/rural areas reported 16,009 deaths. The crude mortality rate (CMR)/100,000 population in urban areas declined from over 0.25 in 1999 to 0.05 in 2020. These rates were however always significantly greater than the CMR in rural areas (0.06 in 1999 and 0.01 in 2020). This disparity was most significant among males, the white race, and those between 35-65 years of age.ConclusionsThis study highlights a statistically significant disparity in urban versus rural mortality rates of HIV especially amongst males, the white race, and people between 35-65 years of age.