Observational studyBMJ global health2023
Income inequality and pandemics: insights from HIV/AIDS and COVID-19-a multicountry observational study.
Observational study in BMJ global health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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The trial behind it
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Who cites it
5 citing papers in PubMed, 14 citations in OpenAlex.
- HIV/AIDS Mortality Trends in Peru: A Natural Experiment of COVID-19's Disruption and Health Disparities (2017-2024).AIDS and behavior · 2026Article
- Temporal trends and associations between domestic public health spending, donor funding and tuberculosis outcomes in Africa: a serial cross-sectional study (1990-2022).BMJ public health · 2026Article
- The global burden, trends, and inequalities of HIV/AIDS: a multicountry observational analysis.BMC infectious diseases · 2025Observational
- Application progress of latent class growth models in dynamic prevention and control strategies for acquired immunodeficiency syndrome.Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences · 2024Review
- Pandemic lessons for the 2024 US presidential election.BMJ (Clinical research ed.) · 2024Article
Corrections and comments
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Authors and funding
4 authors at 4 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesAssess the relationship between income inequality and HIV incidence, AIDS mortality and COVID-19 mortality.
designMulticountry observational study.
setting217 countries for HIV/AIDS analysis, 151 countries for COVID-19 analysis.
participantsUsed three samples of national-level data: a sample of all countries with available data (global sample), a subsample of African countries (African sample) and a subsample excluding African countries (excluding African sample).
main outcome measuresHIV incidence rate per 1000 people, AIDS mortality rate per 100 000 people and COVID-19 excess mortality rate per 100 000 people. The Gini index of income inequality was the primary explanatory variable.
resultsA positive and significant relationship exists between the Gini index of income inequality and HIV incidence across all three samples (p<0.01), with the effect of income inequality on HIV incidence being higher in the African sample than in the rest of the world. Also, a statistically positive association exists for all samples between income inequality and the AIDS mortality rate, as higher income inequality increases AIDS mortality (p<0.01). For COVID-19 excess mortality rate, a positive and statistically significant relationship exists with the Gini index for the entire sample and the excluding African sample (p<0.05), but the African sample alone did not deliver significant results (p<0.1).
conclusionCOVID-19 excess deaths, HIV incidence and AIDS mortality are significantly associated with income inequality globally-more unequal countries have a higher HIV incidence, AIDS mortality and COVID-19 excess deaths than their more equal counterparts. Income inequality undercuts effective pandemic response. There is an urgent need for concerted efforts to tackle income inequality and to build pandemic preparedness and responses that are adapted and responsive to highly unequal societies, prioritising income inequality among other social determinants of health.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.