This study aims to compare the impact of social determinants of health (SDoH) on COVID-19 clinical outcomes between PWH and people without HIV (PWoH) using the population-based National COVID Cohort Collaborative (N3C) data in the United States.

Methods

We included all adult COVID-19 cases from 77 clinical sites with data being deposited into the N3C and harmonized into a data release set from January 1, 2020 through February 27, 2023. The non-billable "Z codes" (ICD codes) specific to SDoH was used as the exposure variable. Logistic regression models estimated the association of Z code with COVID-19-related hospitalization and mortality.

Results

Among 22,441 PWH and 5,149,206 PWoH with COVID-19, 45.4% and 22.2% had documented at least one SDoH specific Z-code, respectively. Problems related to upbringing was the most frequently documented Z-code for both PWH (40.9%) and PWoH (21.1%), although PWH generally had a higher percentage of each item of SDoH than PWoH. In PWoH, nearly all Z-codes were associated with higher odds of COVID-19 related hospitalization; while only some were associated mortality (e.g., problems related to housing and economic circumstances). In contrast, among PWH, similar but fewer Z-codes were associated with hospitalization, while all the significant Z-codes (e.g., problems related to employment) were associated with lower odds of death from COVID-19.

Conclusion

Problems related to housing and economic circumstances and psychosocial circumstances were the most common issues leading to worse COVID-19-related outcomes. We did not find a more severe impact of SDoH on COVID-19 related outcomes for PWH than PWoH.