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)

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

doi:10.1017/cts.2024.550

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)

J Clin Transl Sci. 2024 May 21;8(1):e107. doi: 10.1017/cts.2024.550. eCollection 2024.

Authors

Dimple Vaidya¹, Kenneth J Wilkins², Eric Hurwitz^{3

4}, Jessica Y Islam^{5

6}, Dongmei Li⁷, Jing Sun⁸, Sandra E Safo⁹, Jennifer M Ross¹⁰, Shukri Hassan¹⁰, Elaine Hill¹¹, Bohdan Nosyk¹², Cara D Varley¹³, Nada Fadul¹⁴, Marlene Camacho-Rivera¹⁵, Charisse Madlock-Brown^#¹⁶, Rena C Patel^#^{10

17}

Affiliations

¹ Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, USA.
² Biostatistics Program, Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
³ Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁴ Virginia Commonwealth University, Richmond, VA, USA.
⁵ Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
⁶ Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
⁷ Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, USA.
⁸ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁹ Department of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
¹⁰ Department of Medicine, University of Washington, Seattle, WA, USA.
¹¹ Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
¹² Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
¹³ Oregon Health & Science University, School of Medicine; Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA.
¹⁴ Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
¹⁵ Department of Community Health Sciences, SUNY Downstate School of Public Health, Brooklyn, NY, USA.
¹⁶ Acute and Critical Care Division, College of Nursing, University of Iowa, Iowa City, IA, USA.
¹⁷ Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

^# Contributed equally.

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.

Keywords: COVID-19; Individual-level; human immunodeficiency virus; race/ethnicity; social determinants of health.