Area deprivation index and segregation on the risk of HIV: a U.S. Veteran case-control study

Abiodun O Oluyomi; Angela L Mazul; Yongquan Dong; Donna L White; Christine M Hartman; Peter Richardson; Wenyaw Chan; Jose M Garcia; Jennifer R Kramer; Elizabeth Chiao

doi:10.1016/j.lana.2023.100468

Area deprivation index and segregation on the risk of HIV: a U.S. Veteran case-control study

Lancet Reg Health Am. 2023 Mar 21:20:100468. doi: 10.1016/j.lana.2023.100468. eCollection 2023 Apr.

Authors

Abiodun O Oluyomi^{1

2

3}, Angela L Mazul^{3

4}, Yongquan Dong⁵, Donna L White^{2

5

6

7}, Christine M Hartman⁵, Peter Richardson^{5

7}, Wenyaw Chan⁸, Jose M Garcia⁹, Jennifer R Kramer^{2

5

7}, Elizabeth Chiao¹⁰

Affiliations

¹ Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
² Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.
³ Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA.
⁴ Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
⁵ VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA.
⁶ Center for Translational Research in Inflammatory Disease (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX, USA.
⁷ Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA.
⁸ Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, USA.
⁹ Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System and Div. of Geriatrics, Department of Medicine, University of Washington, Seattle, WA, USA.
¹⁰ Department of Epidemiology, Division of Cancer Prevention and Population Sciences, Department of General Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Abstract

Background: Preventing HIV infection remains a critically important tool in the continuing fight against HIV/AIDS. The primary aim is to evaluate the effect and interactions between a composite area-level social determinants of health measure and an area-level measure of residential segregation on the risk of HIV/AIDS in U.S. Veterans.

Methods: Using the individual-level patient data from the U.S. Department of Veterans Affairs, we constructed a case-control study of veterans living with HIV/AIDS (VLWH) and age-, sex assigned at birth- and index date-matched controls. We geocoded patient's residential address to ascertain their neighborhood and linked their information to two measures of neighborhood-level disadvantage: area deprivation index (ADI) and isolation index (ISOL). We used logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI) for comparing VLWH with matched controls. We performed analyses for the entire U.S. and separately for each U.S. Census division.

Findings: Overall, living in minority-segregated neighborhoods was associated with a higher risk of HIV (OR: 1.88 (95% CI: 1.79-1.97) while living in higher ADI neighborhoods was associated with a lower risk of HIV (OR: 0.88; 95% CI: 0.84-0.92). The association between living in a higher ADI neighborhood and HIV was inconsistent across divisions, while living in minority-segregated neighborhoods was consistently associated with increased risk across all divisions. In the interaction model, individuals from low ADI and high ISOL neighborhoods had a higher risk of HIV in three divisions: East South Central; West South Central, and Pacific.

Interpretation: Our results suggest that residential segregation may prevent people in disadvantaged neighborhoods from protecting themselves from HIV independent from access to health care. There is the need to advance knowledge about the neighborhood-level social-structural factors that influence HIV vulnerability toward developing interventions needed to achieve the goal of ending the HIV epidemic.

Funding: US National Cancer Institute.

Keywords: Epidemiology; HIV; Racial segregation; United States.