Racial disparities in COVID-19 test positivity among people living with HIV in the United States

Abstract

Objective This study aimed to compare COVID-19 positivity by HIV status and race/ethnicity using data from the U.S. National COVID Cohort Collaborative (N3C). Methods The N3C cohort (≥ 18 years) includes patients with any encounter after 1/1/2020 with SARS-CoV-2 laboratory tests. Detailed electronic medical records are centralized and harmonized across health-care organizations (34 sites). COVID-19 diagnosis was defined by RT-PCR or antibody testing. HIV infection was defined by standard diagnostic codes within 2 years prior to COVID-19 testing. Descriptive statistics and multivariable logistic regression were utilized to compare COVID-19 positivity and HIV status by patient’s race/ethnicity. Results Over 2.1 million patients were captured in the N3C as of 01/29/2021, of whom 372,716 (15%) were positive for COVID-19; 17,820 (0.7%) were PLWH of whom 2428 (13.6%) tested positive for COVID-19. COVID-19 positive PLWH were more likely to be 30+ years of age (90% vs. 70%; χ2 p < 0.001), male (67% vs. 46%, χ2 p < 0.001), and Black (44% vs. 15%, χ2 p < 0.001) compared to HIV-negative patients. Compared to non-Hispanic/Latinx (NH)-White PLWH, NH-Black (aOR: 1.59, 95% CI: 1.37–1.86), Latinx (aOR: 2.17, 95% CI: 1.68–2.83), and NH-Asian (aOR: 2.18, 95% CI: 1.30–3.63) PLWH were more likely to have COVID-19 after adjustment for age, sex, and CharlsonDeyo comorbidity score. Conclusion PLWH and minoritized communities, including NH-Black and Latinx or Hispanic adults, appear to be disproportionately impacted by the COVID-19 pandemic.

Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions

“…Beyond clinical indicators, several studies incorporated validated SDoH indexes like the Area Deprivation Index [206,207], Social Deprivation Index [208] and CDC's Social Vulnerability Index [209]. In terms of analysis approaches, common methods included multivariate regression models like logistic regression (n = 13) [159,179,180,192,199,[210][211][212][213][214][215][216][217] and Cox proportional hazards models (n = 3) [138,196,212] to assess adjusted outcome associations with SDoH factors. Other advanced techniques leveraged included machine learning algorithms [215], geospatial analysis for clustering [218], and phenome-wide association studies [150] in select studies.…”

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)

“…Racialized minority communities face not only inequitable exposure due to social vulnerability, but also a higher prevalence of preexisting chronic conditions like HIV. These conditions likely heighten the risk of adverse outcomes from COVID-19, as we have previously shown that racialized minority PWH experienced a disproportionate burden of COVID-19 infections and severity compared to racialized minority people without HIV (PWoH) or White PWH 11 . Given the disproportionate impact of the COVID-19 pandemic on PWH, it is crucial to explore the significance of SDoH to understand potential pathways to mitigate disparities among racial/ethnic minorities affected by HIV.…”