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)

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) · SciRah

^aDepartments of Medicine and Epidemiology, University of Washington, Seattle, WA, USA
^bBiostatistics Program, Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
^cDepartment of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
^dVirginia Commonwealth University, Richmond, VA, USA
^eDepartment of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
^fDepartment of Oncologic Sciences, University of South Florida, Tampa, FL
^gDepartment of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
^hDepartment of Oncologic Sciences, University of South Florida, Tampa, FL, USA
ⁱUniversity of Colorado Anschutz Medical Campus, Department of Biomedical Informatics
^jVirginia Commonwealth University, Richmond, VA
^kDepartment of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, USA
^lDepartment of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY
^mDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
ⁿDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
^oDepartment of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
^pDepartment of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
^qDepartment of Medicine, University of Washington, Seattle, WA, USA
^rDepartments of Medicine, University of Washington, Seattle, WA, USA
^sDepartment of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
^tDepartment of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
^uFaculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
^vOregon Health & Science University, School of Medicine
^wOregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
^xOregon Health & Science University-Portland State University School of Public Health
^yDepartment of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
^zDepartment of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
^aaDepartment of Community Health Sciences, SUNY Downstate School of Public Health, Brooklyn, NY, USA
^abDepartment of Community Health Sciences, SUNY Downstate School of Public Health, Brooklyn, NY
^acAcute and Critical Care Division, College of Nursing, University of Iowa, Iowa City, IA, USA
^adAcute and Critical Care Division, College of Nursing, University of Iowa, Iowa City, Iowa
^aeDepartment of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
✉Corresponding author

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.

TL;DRThe importance of assessing individual-level SDoH variables to unravel the complex interplay of these factors for racialized minority groups is underscores the importance of assessing individual-level SDoH variables in the Healthy People 2030 framework. (Semantic Scholar)

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)

Abstract

Plain-language summary

Discussion