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Associations between social determinants of health and co- and multi-morbidity in people of Black ethnicities with HIV
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Download the PDF here
Dominguez-Dominguez, Lourdesa; Campbell, Lucya,b; Barbini, Birgita,b; Fox, Juliec,d; Nikiphorou, Elenae,f; Goff, Louiseg,h; Lempp, Heidif; Tariq, Shemai; Hamzah, Lisaj,∗; Post, Frank A.a,b,∗
AIDS January 24, 2024
•In our analysis, social isolation, discrimination and financial, food, and job insecurity, were associated with multimorbidity;
•the role of biological pathways in the development of co- and multimorbidity: Several studies have shown chronic inflammation and immune activation, which can occur in the setting of controlled viraemia under optimal ART;
•‘weathering’, accelerated aging related to structural barriers, material hardship and systematic racism in marginalised ethnic groups [73] may play an important role. Persistent stressors are hypothesised to drive adverse outcomes through high allostatic loads, inflammation and/or accelerated epigenetic aging
Blacks have higher rates of morbidity and mortality than Whites for almost all health outcomes in the United States, and this inequality increases with age. Although these racial disparities are notable, their underlying causes are unclear. The weathering hypothesis was proposed to explain racial health disparities. Weathering is the result of chronic exposure to social and economic disadvantage that leads to the acceleration of normal aging and earlier onset of unfavorable physical health conditions among disadvantaged (vs. advantaged) persons of similar age (i.e., weathering pattern).
Objective:
Social Determinants of Health (SDH) are important determinants of long-term conditions and multimorbidity in the general population. The intersecting relationship between SDH and multimorbidity in people with HIV remains poorly studied.
Design:
Cross-sectional study investigating the relationships between eight socio-economic parameters and prevalent comorbidities of clinical significance and multimorbidity in adults of African ancestry with HIV aged 18–65 years in South London, UK.
Conclusions
We demonstrate a strong association between social determinants of health and poor mental health, chronic pain and multimorbidity in people of black ethnicities living with HIV in south London. Tthese current findings highlight the likely impact of enduring socio-economic hardship in these communities and underlines the importance of holistic health and social care for people with HIV to address these adverse psychosocial conditions.
Discussion
In this analysis of data from 398 people of black ethnicities with HIV in South London, 72% of whom had at least one comorbidity, we found a high prevalence of socio-economic deprivation, with 85% reporting at least one adverse SDH. Poor mental health, chronic pain and multimorbidity were associated with multiple SDH including financial insecurity, food insecurity, job insecurity, social isolation, and discrimination. We found no evidence of an association between SDH and diabetes or kidney disease. These data suggest that comorbidities are variably associated with SDH, or that SDH may variably affect the development of comorbidities and multimorbidity.
We report a strong association between poor mental health in people with HIV and SDH including social isolation (32% in this study), discrimination (33%), and job, financial, food and housing insecurity. Socioeconomic inequalities such as debt [49], lower education level, unemployment [50], and low income [51] are well-recognised drivers of poor mental health in the general population. A s/ystematic review of people with HIV in the US noted multiple social determinants of health to be associated with depression, such as income, housing instability, food insecurity, educational attainment, transactional sex and low social support [52], however individual studies lacked the broad approach used in this study.
We also report an association between chronic pain and lower education level, social isolation, discrimination, and job, financial, food and housing insecurity. These effect sizes were smaller than those seen for mental health.
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