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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 article   Open access   Peer reviewed

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, …
Journal of clinical and translational science, Vol.8(1), e107
2024
DOI: 10.1017/cts.2024.550
PMCID: PMC11408162
PMID: 39296577
url
https://doi.org/10.1017/cts.2024.550View
Published (Version of record) Open Access

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.

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