Multidimensional Social Adversity and Mortality in People With HIV Infection and Heart Failure: Insights from NYC Health + Hospitals HIV-Heart Failure Cohort.
| Title: | Multidimensional Social Adversity and Mortality in People With HIV Infection and Heart Failure: Insights from NYC Health + Hospitals HIV-Heart Failure Cohort. |
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| Authors: | Chen YY; Department of Medicine, NYC Health + Hospitals/Jacobi, Bronx, NY. (Y.-Y.C., P.B., L.B., N.N., M.P., A.K., C.V.-P., I.C., J.B., V.G., S.B., R.F., L.P.).; Division of Cardiology, Brown University Health, Providence, RI (Y.-Y.C., W.-C.H.W., E.S.-B.).; Borkowski P; Department of Medicine, NYC Health + Hospitals/Jacobi, Bronx, NY. (Y.-Y.C., P.B., L.B., N.N., M.P., A.K., C.V.-P., I.C., J.B., V.G., S.B., R.F., L.P.).; Division of Cardiology, University of Pittsburgh Medical Center, Harrisburg, PA (P.B.).; Biavati L; Department of Medicine, NYC Health + Hospitals/Jacobi, Bronx, NY. (Y.-Y.C., P.B., L.B., N.N., M.P., A.K., C.V.-P., I.C., J.B., V.G., S.B., R.F., L.P.).; Nazarenko N; Department of Medicine, NYC Health + Hospitals/Jacobi, Bronx, NY. (Y.-Y.C., P.B., L.B., N.N., M.P., A.K., C.V.-P., I.C., J.B., V.G., S.B., R.F., L.P.).; Parker M; Department of Medicine, NYC Health + Hospitals/Jacobi, Bronx, NY. (Y.-Y.C., P.B., L.B., N.N., M.P., A.K., C.V.-P., I.C., J.B., V.G., S.B., R.F., L.P.).; Kharawala A; Department of Medicine, NYC Health + Hospitals/Jacobi, Bronx, NY. (Y.-Y.C., P.B., L.B., N.N., M.P., A.K., C.V.-P., I.C., J.B., V.G., S.B., R.F., L.P.).; Department of Cardiology, University of Nebraska Medical Center, Omaha (A.K.).; Vargas-Pena C; Department of Medicine, NYC Health + Hospitals/Jacobi, Bronx, NY. (Y.-Y.C., P.B., L.B., N.N., M.P., A.K., C.V.-P., I.C., J.B., V.G., S.B., R.F., L.P.).; Department of Medicine, NYU Grossman School of Medicine, New York, NY (C.V.-P.).; Chowdhury I; Department of Medicine, NYC Health + Hospitals/Jacobi, Bronx, NY. (Y.-Y.C., P.B., L.B., N.N., M.P., A.K., C.V.-P., I.C., J.B., V.G., S.B., R.F., L.P.).; Bock J; Department of Medicine, NYC Health + Hospitals/Jacobi, Bronx, NY. (Y.-Y.C., P.B., L.B., N.N., M.P., A.K., C.V.-P., I.C., J.B., V.G., S.B., R.F., L.P.).; Garg V; Department of Medicine, NYC Health + Hospitals/Jacobi, Bronx, NY. (Y.-Y.C., P.B., L.B., N.N., M.P., A.K., C.V.-P., I.C., J.B., V.G., S.B., R.F., L.P.).; Bhakta S; Department of Medicine, NYC Health + Hospitals/Jacobi, Bronx, NY. (Y.-Y.C., P.B., L.B., N.N., M.P., A.K., C.V.-P., I.C., J.B., V.G., S.B., R.F., L.P.).; Department of Critical Care, Montefiore Medical Center, Bronx, NY (S.B.).; Faillace R; Department of Medicine, NYC Health + Hospitals/Jacobi, Bronx, NY. (Y.-Y.C., P.B., L.B., N.N., M.P., A.K., C.V.-P., I.C., J.B., V.G., S.B., R.F., L.P.).; Department of Cardiology (R.F.), NYC Health + Hospitals/Jacobi, Bronx, NY.; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.F., L.P.).; Palaiodimos L; Department of Medicine, NYC Health + Hospitals/Jacobi, Bronx, NY. (Y.-Y.C., P.B., L.B., N.N., M.P., A.K., C.V.-P., I.C., J.B., V.G., S.B., R.F., L.P.).; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.F., L.P.).; Wu WH; Division of Cardiology, Brown University Health, Providence, RI (Y.-Y.C., W.-C.H.W., E.S.-B.).; Department of Medicine, Providence VA Medical Center, RI (W.-C.H.W., S.E.).; Salmoirago-Blotcher E; Division of Cardiology, Brown University Health, Providence, RI (Y.-Y.C., W.-C.H.W., E.S.-B.).; Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI (E.S.-B.).; Erqou S; Department of Medicine, Providence VA Medical Center, RI (W.-C.H.W., S.E.).; Division of Cardiology, Mary-Washington Hospital, Fredericksburg, VA (S.E.).; Longenecker CT; Division of Cardiology, University of Washington School of Medicine, Seattle (C.T.L.).; Department of Global Health, University of Washington, Seattle (C.T.L.). |
| Source: | Circulation [Circulation] 2026 May 19. Date of Electronic Publication: 2026 May 19. |
| Publication Model: | Ahead of Print |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0147763 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4539 (Electronic) Linking ISSN: 00097322 NLM ISO Abbreviation: Circulation Subsets: MEDLINE |
| Imprint Name(s): | Publication: Hagerstown, MD : Lippincott Williams & Wilkins; Original Publication: [Dallas, Tex., etc., American Heart Association, etc.] |
| Abstract: | Background: Heart failure is an increasingly common comorbidity among people with HIV infection, complicating care and heightening the vulnerability of this population to social adversity (SA). However, the impact of different SA domains on outcomes in this population remains poorly understood.; Methods: We analyzed data on people with HIV infection and heart failure from the NYC 4H (NYC Health + Hospitals HIV-Heart Failure) cohort. Baseline multidimensional SA was assessed by licensed clinical social workers using standardized evaluations and grouped into 5 domains: economic hardship, health care access barriers, neighborhood or built environment instability, social support challenge, and psychobehavioral instability. We used multivariable adjusted Cox models to estimate hazard ratios (HRs) of all-cause, cardiovascular, and infection-related mortality and logistic regression to estimate odds ratios of 6-month rehospitalization risk.; Results: Among 1044 participants (62.9% male; mean age, 61.6 years), 601 (58%) reported at least 1 SA: economic hardship (n=130), limited health care access (n=155), unstable housing (n=129), social support challenge (n=179), or psychobehavioral instability (n=438). Over a mean follow-up of 3.8 years, exposure to any SA was associated with higher all-cause mortality (HR, 4.32 [95% 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 challenge (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 challenge (HR, 3.09 [95% CI, 1.75-5.48]) were associated with higher infection-related mortality. Compared with patients without SA, those with environmental instability, psychobehavioral instability, or social support challenges had a 73% (adjusted odds ratio, 1.73 [95% CI, 1.15-2.06]), 75% (adjusted odds ratio, 1.75 [95% CI, 1.31-2.35]), and 44% (adjusted odds ratio, 1.44 [95% CI, 1.00-2.06]) higher risk of rehospitalization within 6 months, respectively.; Conclusions: SA was significantly associated with mortality and rehospitalization among people with HIV infection and heart failure, with domain-specific pathways influencing specific outcomes. Multidimensional assessment of SA may offer a framework for domain-specific risk stratification in people with HIV infection and heart failure. |
| Contributed Indexing: | Keywords: HIV; heart failure; mortality; social alienation; social determinants of health |
| Entry Date(s): | Date Created: 20260519 Latest Revision: 20260519 |
| Update Code: | 20260519 |
| DOI: | 10.1161/CIRCULATIONAHA.126.078897 |
| PMID: | 42153290 |
| Database: | MEDLINE |
Journal Article