Heart failure is becoming increasingly common among people with HIV infection, adding complexity to clinical care and potentially amplifying the effects of social adversity. An analysis from the NYC Health + Hospitals HIV–Heart Failure cohort published in Circulation evaluated the relationship between multidimensional social adversity and clinical outcomes in this population.
The study analyzed 1,044 adults with HIV infection and heart failure from the NYC 4H cohort. Baseline social adversity assessments were conducted by licensed clinical social workers using standardized evaluations and grouped into five domains: economic hardship, health care access barriers, neighborhood or built environment instability, social support challenge, and psychobehavioral instability.
Multivariable Cox proportional hazards models were used to assess associations with all-cause, cardiovascular, and infection-related mortality, while logistic regression analyses evaluated risk of rehospitalization within 6 months.
Findings
- Exposure to any social adversity was associated with higher all-cause mortality (hazard ratio [HR], 4.32; 95% confidence interval [CI], 3.03-6.14), cardiovascular mortality (HR, 4.05; 95% CI, 2.17-6.83), and infection-related mortality (HR, 2.37; 95% CI, 1.23-4.56).
- Social support challenges (HR, 2.19; 95% CI, 1.35-3.55) and psychobehavioral instability (HR, 1.96; 95% CI, 1.24-3.11) were associated with higher cardiovascular mortality.
- Economic hardship (HR, 2.40; 95% CI, 1.22-4.70) and social support challenges (HR, 3.09; 95% CI, 1.75-5.48) were associated with higher infection-related mortality.
- Environmental instability, psychobehavioral instability, and social support challenges were associated with higher 6-month rehospitalization risk, with adjusted odds ratios of 1.73 (95% CI, 1.15-2.06), 1.75 (95% CI, 1.31-2.35), and 1.44 (95% CI, 1.00-2.06), respectively.
Multidimensional social adversity was associated with higher mortality and rehospitalization risk among people with HIV infection and heart failure. Different social adversity domains were linked to distinct clinical outcomes, supporting the potential role of domain-specific risk assessment in this population.
