Assessing associations between individual-level social determinants of health and COVID-19 hospitalizations: investigating racial/ethnic disparities among people living with HIV in the U.S. National COVID Cohort Collaborative (N3C)

Dimple Vaidya, Kenneth J. Wilkins, Eric Hurwitz, Jessica Y. Islam, Dongmei Li, Jing Sun, Sandra E. Safo, Jennifer M. Ross, Shukri Hassan, Elaine Hill, Bohdan Nosyk, Cara D. Varley, Nada Fadul, Marlene Camacho-Rivera, Charisse Madlock-Brown, Rena C. Patel

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Leveraging the National COVID-19 Cohort Collaborative (N3C), a nationallysampled electronic health records (EHR) repository, we explored associations between individual-level social determinants of health (SDoH) and COVID-19-related hospitalizations among racialized minority people with 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.

Original languageEnglish (US)
JournalJournal of Clinical and Translational Science
DOIs
StateAccepted/In press - 2024

Bibliographical note

Publisher Copyright:
© 2024 Cambridge University Press. All rights reserved.

Keywords

  • COVID-19
  • HIV
  • Individual-level
  • race/ethnicity
  • social determinants of health

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