Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, MRC - CANCONT, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
AIDS Behav. 2024 Oct;28(Suppl 1):136-148. doi: 10.1007/s10461-024-04466-0. Epub 2024 Sep 18.
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.
单独来看，由于社会决定因素（SDoH）在美国的作用，COVID-19 和 HIV 大流行对少数群体产生了不同的影响。目前还不清楚这两种大流行的碰撞可能如何加剧不利的健康后果。我们评估了县级 SDoH 与 COVID-19 诊断后住院之间的关联，对象是有（PWH）和没有 HIV（PWOH）的人群，按种族/族裔群体进行分类。我们使用美国全国 COVID 队列协作（2020 年 1 月至 2023 年 11 月），这是一个全国性抽样的电子健康记录存储库，确定了患有 COVID-19 伴 HIV（n=22491）和不伴 HIV（n=2220660）的成年人。我们在县级汇总 SDoH 措施，并将种族/族裔群体分类为非西班牙裔（NH）白人、NH 黑人、西班牙裔/拉丁裔、NH 亚裔和太平洋岛民（AAPI）以及 NH 美洲印第安人或阿拉斯加原住民（AIAN）。为了估计县级 SDoH 与 COVID-19 诊断后住院之间的关联，我们使用了多层次、多变量逻辑回归，计算调整后的相对风险（aRR）和 95%置信区间（95%CI）。COVID-19 相关住院发生在 11%的 PWH 和 7%的 PWOH 中，NH 黑人 PWH 的比例最高（15%）。在评估 PWH 中的县级 SDoH 时，我们发现平均家庭规模越大，不同种族/族裔群体 COVID-19 相关住院的风险越低。平均通勤时间较长（aRR：1.76；95%CI 1.10-2.62）和没有医疗保险的成年人比例较高（aRR：1.40；95%CI 1.04-1.84）与 NH 黑人 PWH 的 COVID-19 住院风险增加相关，但 NH 黑人 PWOH 并未表现出这些关联。在美国，有和没有 HIV 的人群中，不利的县级 SDoH 与 COVID-19 结果之间的关联存在种族和族裔差异。
