Racial Disparities Extend to Common Comorbidities Among Persons in Care for HIV Infection
Year: 2015
Type: article
Study design: Observational Study
Abstract: Background. Prior studies have described racial disparities in viral control (i.e. serum HIV RNA level below limits of detetction) among persons taking combination antiretroviral therapy (cART) for HIV infection. However, it is unclear if racial disparities extend to control of the common comorbidities that are increasingly the focus of HIV care. We aimed to quantify racial variation in viral control, hypertension (HTN) control, and diabetes (DM) control among Veterans receiving care for HIV infection in Veterans Health Administration (VHA). Methods. We used national VHA data from 2013 to create a cohort of 25,676 Veterans in care for HIV. We quantified viral control (i.e. last serum HIV RNA ≤200 copies/mL among Veterans on cART), HTN control (i.e. last blood pressure <140/90mmHg among Veterans with HIV and HTN), and DM control (i.e. last hemoglobin A1C <9% among Veterans with HIV and DM). We used multivariable logistic regression to determine associations between these measures and race, after adjusting for age, sex, other comorbidities, nadir CD4 cell count, residential ZIP-code level poverty rates from census data, and retention in care (i.e. ≥2 clinic visits in year at least 60 days apart). Results. Approximately half (50.1%) of the cohort was black, 43.7% were white, and 6.2% were of other or unknown race. Most received cART (N = 23,444, 91.3%); whereas 9854 (38.4%) had a HTN diagnosis; and 4294 (16.7%) had a DM diagnosis. Blacks were less likely than whites to experience viral control (81.7% versus 89.7%, P ≤ .0001), HTN control (73.8% versus 79.1%, P ≤ .0001), and DM control (94.8% versus 96.8%, P ≤ .0001). Racial differences persisted in multivariable models (multivariable odds ratio for blacks referent to whites 0.65 [95% CI, 0.59–0.72] for viral control, 0.77 [95% CI, 0.70–0.85] for BP control, and 0.79 [95% CI, 0.63–0.99] for DM control). Conclusion. Even in an equal-access healthcare system with minimal barriers to care related to health insurance or co-pays, racial disparities existed in HIV care. Disparities extended to common comorbidities. Efforts to reduce racial disparities in HIV care should examine comprehensive measures for comorbidity control, as well as viral control. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Authors: Kelly Richardson, Holly Swan, Donald Mcinnes, Vera Yakochenko, Leonore Okwara, Amanda Midboe, Barbara Bokhour, Michael Ohl
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2259788037