Journal article
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)
Journal of clinical and translational science, Vol.8(1), e107
2024
DOI: 10.1017/cts.2024.550
PMCID: PMC11408162
PMID: 39296577
Abstract
Background: Leveraging the National COVID-19 Cohort Collaborative (N3C), a nationally-sampled 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.
Details
- Title: Subtitle
- 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)
- Creators
- Dimple Vaidya - University of WashingtonKenneth J. Wilkins - National Institute of Diabetes and Digestive and Kidney DiseasesEric Hurwitz - University of South FloridaJessica Y. Islam - University of Colorado Anschutz Medical CampusDongmei Li - University of Rochester Medical CenterJing Sun - Johns Hopkins UniversitySandra E. Safo - University of MinnesotaJennifer M. RossShukri Hassan - University of WashingtonElaine Hill - University of Rochester Medical CenterBohdan Nosyk - Simon Fraser UniversityCara D. Varley - Oregon Health & Science UniversityNada Fadul - University of Nebraska Medical CenterMarlene Camacho-RiveraCharisse Madlock-BrownRena C. Patel - University of Alabama at Birmingham
- Resource Type
- Journal article
- Publication Details
- Journal of clinical and translational science, Vol.8(1), e107
- Publisher
- Cambridge University Press
- DOI
- 10.1017/cts.2024.550
- PMID
- 39296577
- PMCID
- PMC11408162
- ISSN
- 2059-8661
- eISSN
- 2059-8661
- Language
- English
- Electronic publication date
- 2024
- Academic Unit
- Nursing
- Record Identifier
- 9984634259002771
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