Racial/Ethnic and Income Disparities in the Prevalence of Comorbidities That Are Associated With Risk for Severe COVID-19 Among Adults Receiving HIV Care, United States, 2014–2019

John K. Weiser, MD, MPH; Yunfeng Tie, PhD; Linda Beer, PhD; Robyn Neblett Fanfair, MD, MPH; Roy Luke Shouse, MD, MPH

Disclosures

J Acquir Immune Defic Syndr. 2021;86(3):297-304. 

In This Article

Results

The sociodemographic characteristics of people receiving HIV care during June 2014–May 2019 are displayed in Table 1. Clinical characteristics are displayed in Table 2. An estimated 12.3% (95% CI: 11.4 to 13.1) had diagnosed obesity, 11.7% (95% CI: 10.8 to 12.6) had CKD, 12.6% (95% CI: 11.9 to 13.4) had diabetes, 10.1% (95% CI: 9.4 to 10.8) had COPD, 0.1% (95% CI: 0.1 to 0.2) were immunocompromised from organ transplantation, 9.3% (95% CI: 8.7 to 10.0) had heart disease, and 37.9% (95% CI: 36.6 to 39.2) had ≥1 diagnosed comorbidity associated with an increased risk for severe illness from COVID-19 (Table 2). An estimated 51.6% (95% CI: 50.4 to 52.8) were aged ≥50 years, 8.3% (95% CI: 7.5 to 9.0) were aged ≥65 years, and 35.8% (95% CI: 34.4 to 37.2) had poorly controlled HIV. Prevalence estimates of combinations of these characteristics are presented in Table 2. PDs for having ≥1 diagnosed comorbidity are displayed in Table 3 and Figure 2. Compared with White adults, Black adults were more likely [adjusted PD (APD), 7.8 percentage points (95% CI: 5.7 to 10.0)] and Asian adults were less likely [APD, −13.7 percentage points (95% CI, −22.3 to −5.0)] to have ≥1 diagnosed comorbidity, after adjusting for age differences (for the median age of categories within each variable see Table 1, Supplemental Digital Content, http://links.lww.com/QAI/B588). There were no meaningful differences in the prevalence of having ≥1 diagnosed comorbidity between White adults and adults of any other race/ethnicity. APDs for race/ethnicity were not substantially different among those with incomes above vs. at or below the poverty threshold (see Table 2, Supplemental Digital Content, http://links.lww.com/QAI/B588). The likelihood of having ≥1 diagnosed comorbidity was higher among those with incomes at or below vs. above the poverty threshold [PD, 7.3 percentage points (95% CI: 5.1 to 9.4)]. Compared with people with any private insurance, those with public insurance alone were more likely [PD, 10.2 percentage points (95% CI: 8.3 to 12.2)] and those with RWHAP assistance alone were less likely [PD, −8.4 percentage points (95% CI, −11.5 to −5.2)] to have ≥1 diagnosed comorbidity. The likelihood of having ≥1 diagnosed comorbidity did not differ among adults receiving HIV care at RWHAP-funded vs. non–RWHAP-funded facilities.

Figure 2.

Prevalence difference of having ≥1 diagnosed comorbidities associated with severe COVID-19 among people receiving HIV care in the United States, 2014–2019, the Medical Monitoring Project, N = 4473. A, Race/ethnicity, adjusted for age, reference group is White, non-Hispanic adults. B, Income at or below the poverty threshold, unadjusted, reference is income above the poverty threshold. C, Type of health insurance, unadjusted, reference is any private insurance. D, Ryan White HIV/AIDS Program funding of the usual place of care (health care facility), unadjusted, reference is no funding. Dashed red line is the meaningful threshold of increased prevalence. Dashed blue line is the meaningful threshold of decreased prevalence. Solid black line is the null threshold. aUnstable estimate (coefficient of variation is ≥0.3, absolute confidence interval is ≥30, and/or relative confidence interval is >130%). bPoverty guidelines as defined by the Department of Health and Human Services: https://aspe.hhs.gov/frequently-askedquestions-related-poverty-guidelines-and-poverty. cParticipants could select more than 1 response for health insurance or coverage for medications. dAny RWHAP funding (parts A, B, C, D, or F).

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