Assessing Associations Between Individual-Level Social Determinants of Health and COVID-19 Hospitalizations: Investigating Racial/ethnic Disparities Among People Living with Human Immunodeficiency Virus (HIV) in the U.S. National COVID Cohort Collaborativ

Authors

Dimple Vaidya, University of Washington
Kenneth J. Wilkins, National Institutes of Health
Eric Hurwitz, University of Colorado Anschutz Medical Campus
Jessica Y. Islam, University of South Florida
Dongmei Li, University of Rochester Medical Center
Jing Sun, Johns Hopkins Bloomberg School of Public Health
Sandra E. Safo, University of Minnesota
Jennifer M. Ross, University of Washington
Cara D. Varley, Portland State UniversityFollow
multiple additional authors

Published In

Journal of Clinical and Translational Science

Document Type

Article

Publication Date

5-20-2024

Subjects

COVID 19 (Disease) -- United States -- Health Care

Abstract

Abstract Background: Leveraging the National COVID-19 Cohort Collaborative (N3C), a nationally sampled electronic health records repository, we explored associations between individual-level social determinants of health (SDoH) and COVID-19-related hospitalizations among racialized minority people with human immunodeficiency virus (HIV) (PWH), who have been historically adversely affected by SDoH. Methods: We retrospectively studied PWH and people without HIV (PWoH) using N3C data from January 2020 to November 2023. We evaluated SDoH variables across three domains in the Healthy People 2030 framework: (1) healthcare access, (2) economic stability, and (3) social cohesion with our primary outcome, COVID-19-related hospitalization. We conducted hierarchically nested additive and adjusted mixed-effects logistic regression models, stratifying by HIV status and race/ethnicity groups, accounting for age, sex, comorbidities, and data partners. Results: Our analytic sample included 280,441 individuals from 24 data partner sites, where 3,291 (1.17%) were PWH, with racialized minority PWH having higher proportions of adverse SDoH exposures than racialized minority PWoH. COVID-19-related hospitalizations occurred in 11.23% of all individuals (9.17% among PWH, 11.26% among PWoH). In our initial additive modeling, we observed that all three SDoH domains were significantly associated with hospitalizations, even with progressive adjustments (adjusted odds ratios [aOR] range 1.36–1.97). Subsequently, our HIV-stratified analyses indicated economic instability was associated with hospitalization in both PWH and PWoH (aOR range 1.35–1.48). Lastly, our fully adjusted, race/ethnicity-stratified analysis, indicated access to healthcare issues was associated with hospitalization across various racialized groups (aOR range 1.36–2.00). Conclusion: Our study underscores the importance of assessing individual-level SDoH variables to unravel the complex interplay of these factors for racialized minority groups.

Rights

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

Locate the Document

https://doi.org/10.1017/cts.2024.550

DOI

10.1017/cts.2024.550

Persistent Identifier

https://archives.pdx.edu/ds/psu/42488

Citation Details

Vaidya, D., Wilkins, K. J., Hurwitz, E., Islam, J. Y., Li, D., Sun, J., Safo, S. E., Ross, J. M., Hassan, S., Hill, E., Nosyk, B., Varley, C. D., Fadul, N., Camacho-Rivera, M., Madlock-Brown, C., & Patel, R. C. (2024). Assessing associations between individual-level social determinants of health and COVID-19 hospitalizations: Investigating racial/ethnic disparities among people living with human immunodeficiency virus (HIV) in the U.S. National COVID Cohort Collaborative (N3C). Journal of Clinical and Translational Science, 8(1).