Associations of County-Level Social Determinants of Health with COVID-19 Related Hospitalization Among People with HIV: A Retrospective Analysis of the U.S. National COVID Cohort Collaborative (N3C)

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

doi:10.1007/s10461-024-04466-0

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Associations of County-Level Social Determinants of Health with COVID-19 Related Hospitalization Among People with HIV: A Retrospective Analysis of the U.S. National COVID Cohort Collaborative (N3C)

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Associations of County-Level Social Determinants of Health with COVID-19 Related Hospitalization Among People with HIV: A Retrospective Analysis of the U.S. National COVID Cohort Collaborative (N3C)

Jessica Y Islam, Eric Hurwitz, Dongmei Li, Marlene Camacho-Rivera, Jing Sun, Sandra Safo, Jennifer M Ross, Kenneth Wilkins, Shukri Hassan, Elaine L Hill, …

AIDS and behavior, Vol.28(S1), pp.136-148

10/2024

DOI: 10.1007/s10461-024-04466-0

PMCID: PMC11469976

PMID: 39292319

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Abstract

Individually, the COVID-19 and HIV pandemics have differentially impacted minoritized groups due to the role of social determinants of health (SDoH) in the U.S. Little is known how the collision of these two pandemics may have exacerbated adverse health outcomes. We evaluated county-level SDoH and associations with hospitalization after a COVID-19 diagnosis among people with (PWH) and without HIV (PWOH) by racial/ethnic groups. We used the U.S. National COVID Cohort Collaborative (January 2020-November 2023), a nationally-sampled electronic health record repository, to identify adults who were diagnosed with COVID-19 with HIV (n = 22,491) and without HIV (n = 2,220,660). We aggregated SDoH measures at the county-level and categorized racial/ethnic groups as Non-Hispanic (NH) White, NH-Black, Hispanic/Latinx, NH-Asian and Pacific Islander (AAPI), and NH-American Indian or Alaskan Native (AIAN). To estimate associations of county-level SDoH with hospitalization after a COVID-19 diagnosis, we used multilevel, multivariable logistic regressions, calculating adjusted relative risks (aRR) with 95% confidence intervals (95% CI). COVID-19 related hospitalization occurred among 11% of PWH and 7% of PWOH, with the highest proportion among NH-Black PWH (15%). In evaluating county-level SDoH among PWH, we found higher average household size was associated with lower risk of COVID-19 related hospitalization across racial/ethnic groups. Higher mean commute time (aRR: 1.76; 95% CI 1.10-2.62) and higher proportion of adults without health insurance (aRR: 1.40; 95% CI 1.04-1.84) was associated with a higher risk of COVID-19 hospitalization among NH-Black PWH, however, NH-Black PWOH did not demonstrate these associations. Differences by race and ethnicity exist in associations of adverse county-level SDoH with COVID-19 outcomes among people with and without HIV in the U.S.Individually, the COVID-19 and HIV pandemics have differentially impacted minoritized groups due to the role of social determinants of health (SDoH) in the U.S. Little is known how the collision of these two pandemics may have exacerbated adverse health outcomes. We evaluated county-level SDoH and associations with hospitalization after a COVID-19 diagnosis among people with (PWH) and without HIV (PWOH) by racial/ethnic groups. We used the U.S. National COVID Cohort Collaborative (January 2020-November 2023), a nationally-sampled electronic health record repository, to identify adults who were diagnosed with COVID-19 with HIV (n = 22,491) and without HIV (n = 2,220,660). We aggregated SDoH measures at the county-level and categorized racial/ethnic groups as Non-Hispanic (NH) White, NH-Black, Hispanic/Latinx, NH-Asian and Pacific Islander (AAPI), and NH-American Indian or Alaskan Native (AIAN). To estimate associations of county-level SDoH with hospitalization after a COVID-19 diagnosis, we used multilevel, multivariable logistic regressions, calculating adjusted relative risks (aRR) with 95% confidence intervals (95% CI). COVID-19 related hospitalization occurred among 11% of PWH and 7% of PWOH, with the highest proportion among NH-Black PWH (15%). In evaluating county-level SDoH among PWH, we found higher average household size was associated with lower risk of COVID-19 related hospitalization across racial/ethnic groups. Higher mean commute time (aRR: 1.76; 95% CI 1.10-2.62) and higher proportion of adults without health insurance (aRR: 1.40; 95% CI 1.04-1.84) was associated with a higher risk of COVID-19 hospitalization among NH-Black PWH, however, NH-Black PWOH did not demonstrate these associations. Differences by race and ethnicity exist in associations of adverse county-level SDoH with COVID-19 outcomes among people with and without HIV in the U.S.

Social determinants of health

Race and ethnicity

HIV

COVID-19 hospitalization

SARS-CoV-2 infection

Pandemic

Access to care

Area-level

County-level

Details

Title: Subtitle: Associations of County-Level Social Determinants of Health with COVID-19 Related Hospitalization Among People with HIV: A Retrospective Analysis of the U.S. National COVID Cohort Collaborative (N3C)
Creators: Jessica Y Islam - University of South Florida
Eric Hurwitz - University of Colorado Anschutz Medical Campus
Dongmei Li - University of Rochester Medical Center
Marlene Camacho-Rivera - SUNY Downstate Health Sciences University
Jing Sun - Johns Hopkins University
Sandra Safo - University of Minnesota
Jennifer M Ross - University of Washington
Kenneth Wilkins - National Institutes of Health
Shukri Hassan - University of Washington
Elaine L Hill - University of Rochester
Bohdan Nosyk - Simon Fraser University
Cara Varley - Oregon Health & Science University
Nada Fadul - University of Nebraska Medical Center
Charisse Madlock-Brown - University of Iowa
Rena C Patel - University of Washington
Resource Type: Journal article
Publication Details: AIDS and behavior, Vol.28(S1), pp.136-148
DOI: 10.1007/s10461-024-04466-0
PMID: 39292319
PMCID: PMC11469976
NLM abbreviation: AIDS Behav
ISSN: 1573-3254
eISSN: 1573-3254
Publisher: SPRINGER/PLENUM PUBLISHERS
Grant note: National Center for Advancing Translational Sciences (NCATS): U24 TR002306 U.S. National Institutes of Health (NIMH): R01MH131542
This study accessed data and tools through the N3C Data Enclave (ncats.nih.gov/n3c/about), which is supported by grant U24 TR002306 from National Center for Advancing Translational Sciences (NCATS). National COVID Cohort Collaborative (N3C) is funded by grant U24 TR002306 from NCATS. This work is supported by the U.S. National Institutes of Health (NIMH R01MH131542, PI Rena C. Patel). The funders had no role in study design, analysis, or decision to submit manuscript for publication.
Language: English
Electronic publication date: 09/18/2024
Date published: 10/2024
Academic Unit: Nursing
Record Identifier: 9984704840202771

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