Associations between social determinants of health and comorbidity and multimorbidity in people of black ethnicities with HIV

Abstract

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. Methods: Multivariable logistic regression analysis was used to evaluate associations between SDH and comorbidities and multimorbidity. Results: Between September 2020 and January 2022, 398 participants (median age 52 years, 55% female) were enrolled; 85% reported at least one SDH and 72% had at least one comorbidity. There were no associations between SDH and diabetes mellitus or kidney disease, few associations between SDH (job and food insecurity) and cardiovascular or lung disease, and multiple associations between SDH (financial, food, housing and job insecurity, low educational level, social isolation, and discrimination) and poor mental health or chronic pain. Associations between SDH and multimorbidity mirrored those for constituent comorbidities. Conclusions: We demonstrate strong associations between SDH and poor mental health, chronic pain and multimorbidity in people of black ethnicities living with HIV in the UK. These 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.

Social determinants of health and long‐term conditions in people of Black African and Black Caribbean ethnicity living with HIV in London: A qualitative study

“…4 Multimorbidity has been shown to be associated with income, race and education amongst people living with HIV. 8,9 This is of particular importance given the high levels of socioeconomic deprivation amongst people living with HIV. In the United Kingdom, it is estimated that one-third of individuals living with HIV lack the resources to consistently meet their basic needs, with a notable overrepresentation of people from racially minoritised communities.…”

“…the potential to elucidate the complex interplay by which SDoH lead to poor health outcomes, as well as providing insight into the challenges and solutions within communities. This qualitative study was nested within a larger quantitative study investigating SDoH and co-and multimorbidity in people of Black ethnicities living with HIV in London 9. …”