Racial differences in people living with HIV and Heart Failure: Insight from New York City health and hospitals HIV Heart Failure Cohort

Abstract

Background Racial disparities, an imbalance between the treatment of racial groups, in healthcare significantly affect the prognosis and treatment outcomes for people living with HIV (PLHIV) and heart failure (HF). The complexity of racial disparities in health care is exacerbated when social determinants of health (SDoH). Utilizing the New York City Health and Hospitals HIV Heart Failure (NYC 4H) cohort, one of the largest public health providers in New York City, this study aims to describe the epidemiological characteristics, treatment, and mortality differences among various racial groups in patients living with HIV (PLHIV) and HF. Methods This study utilized data from the mixed retrospective and prospective NYC 4H cohort, comprised of adult individuals with confirmed HIV and HF from inpatient or clinic visits between July 2017 and June 2022. from eleven major New York City Health and Hospitals. Racial identification was reported by the patients. Social adversities (SA) were assessed through a psychosocial evaluation conducted by licensed clinical social workers (LCSWs) during the initial clinic or hospital encounter within the enrollment period. Each patient’s home address was mapped to the area deprivation index (ADI) to obtain ADI ranking and further characterize socioeconomic disadvantage. We assessed the relationship between social adversities and overall mortality in each racial group using hazard ratios (HRs) derived from proportional hazard regression models. Results In total, 1044 patients, including 631 Black/African American, 289 Hispanic/Latino, 57 non-Hispanic White, 17 Asian/Pacific Islander, and 50 of unknown or other racial backgrounds were analyzed in the study. An average follow-up time is 3.8 years. Significant racial difference in ischemic cardiomyopathy, with the highest occurrence found in the Black/African American group (51%) were noticed comparing to Asian/ Pacific Islander (2.3%) and Other/Unknown groups (5.6%) (P < 0.001). The rate of coronary artery bypass grafting (CABG) among the African American population (1.9%) is notably lower (P < 0.001) compared to other racial groups. Based on statewide ADI ranking, all patients disproportionately clustered in the most disadvantaged neighborhood areas, however patients identifying as Black/African American and Hispanic/Latino were more likely to reside in areas with higher ADI score. Asian/ Pacific Islander populations have experienced fewer social adversities, with 76.5% reporting no encounters with social adversity, compared to 41% for Black/African American, 44.3% for Hispanic/Latino, 45.6% for non-Hispanic White, and 34% for Other/Unknown groups. Non-Hispanic White group exhibited a higher prevalence of LGBTQ individuals at 10.5%, a identity not commonly listed among the top challenge for other racial groups (P = 0.002). During the follow-up period, a total of 259 deaths were recorded. The mortality rate is lowest in Asian/Pacific Islanders (11.8%), while comparing to non-Hispanic Whites (33.3%) and unknown or other races (50%). Conclusions Significant differences exist in comorbidities, disease management, and social conditions among HIV and heart failure patients across five racial groups. The findings suggest that within impoverished multiethnic communities, it is crucial to conduct comprehensive screenings for social adversities across all racial groups, as social disadvantage may manifest in various ways.