2020~2024年永川区HIV/AIDS患者ART启动时滞的社会职业分类差异分析

Social-Occupational Disparities in Time to ART Initiation among HIV/AIDS Patients in Yongchuan District, China (2020~2024)

摘要: 目的：探讨职业分类对人类免疫缺陷病毒感染者/艾滋病患者(HIV/AIDS)首次高效抗逆转录病毒治疗(HAART)启动时间的影响，识别治疗延迟的关键人群及其背后机制，为制定精准干预策略提供循证依据。方法：采用队列研究方法，通过中国疾病预防控制信息系统艾滋病综合防治信息系统，收集永川区2020年1月至2024年12月间所有新报告且符合纳入标准的1959例HIV/AIDS患者的资料按职业分三类：一类(干部、医务人员等)、二类(工人、商业服务等)、三类(农民、民工、离退人员等)。采用χ²检验与多因素Logistic回归分析职业对“确诊30天内启动治疗”的影响。结果：三类职业患者年龄较大、文化较低、基线免疫较差。30天内治疗启动率一类为89.6%、二类75.8%、三类82.8%，差异显著(P=0.041)。回归分析显示，一、二类职业是及时治疗的独立促进因素(aOR分别为1.82和1.51)。结论：职业类别是影响治疗启动的重要社会因素，三类职业人群因面临多重脆弱性，成为治疗延迟风险核心人群。应建立基于职业的精准干预，加强对该人群的服务与社会支持，以缩短确诊至治疗时间。

Abstract: Objective: To explore the impact of occupational classification on the time to initiation of first highly active antiretroviral therapy (HAART) among people living with HIV/AIDS, identify key populations experiencing treatment delay and underlying mechanisms, and provide evidence for developing targeted intervention strategies. Methods: A cohort study was conducted. Data from 1959 newly reported and eligible HIV/AIDS cases in Yongchuan District from January 2020 to December 2024 were collected via the China CDC's Comprehensive AIDS Prevention and Control Information System. Patients were categorized into three occupational groups: Class I (e.g., officials, medical staff, teachers, students; n = 67), Class II (e.g., workers, commercial/service/food industry employees, public place attendants, sailors/long-distance drivers; n = 128), and Class III (e.g., farmers, migrant workers, retirees; n = 1764). The chi-square test and multivariable logistic regression were used to analyze the association between occupational class and treatment initiation within 30 days of diagnosis (“timely treatment”). Results: Significant differences were found in demographic and baseline immunological characteristics among the occupational groups (P < 0.001). Class III patients were generally older, had lower education levels, and poorer baseline immune status (51.1% had CD4 ≤ 200 cells/μL). The rates of timely treatment initiation were 89.6% for Class I, 75.8% for Class II, and 82.8% for Class III, with a statistically significant difference (χ² = 12.59, P = 0.041). Multivariable analysis, using Class III as reference, identified Class I (aOR = 1.82, 95%CI: 1.02~3.25, P = 0.043) and Class II (aOR = 1.51, 95%CI: 1.05~2.17, P = 0.027) as independent facilitators of timely treatment. Conclusion: Occupational classification is a significant social determinant affecting the timing of ART initiation. Patients in Class III occupations (predominantly farmers, migrant workers, and retirees), facing “multiple vulnerabilities” related to socioeconomic status, health literacy, and healthcare access, constitute the core population at risk for treatment delay. An occupational classification-based, precise public health intervention model should be established, focusing on strengthening outreach, proactive follow-up, and social support for Class III populations to reduce the diagnosis-to-treatment interval and contribute to HIV/AIDS control goals.