Racial/Ethnic and Income Disparities in the Prevalence of Comorbidities that Are Associated With Risk for Severe COVID-19 Among Adults Receiving HIV Care, United States, 2014-2019

Abstract

Background: Health inequities among people with HIV may be compounded by disparities in the prevalence of comorbidities associated with an increased risk of severe illness from COVID-19.

Setting: Complex sample survey designed to produce nationally representative estimates of behavioral and clinical characteristics of adults with diagnosed HIV in the United States.

Methods: We estimated the prevalence of having ≥1 diagnosed comorbidity associated with severe illness from COVID-19 and prevalence differences (PDs) by race/ethnicity, income level, and type of health insurance. We considered PDs ≥5 percentage points to be meaningful from a public health perspective.

Results: An estimated 37.9% [95% confidence interval (CI): 36.6 to 39.2] of adults receiving HIV care had ≥1 diagnosed comorbidity associated with severe illness from COVID-19. Compared with non-Hispanic Whites, non-Hispanic Blacks or African Americans were more likely [adjusted PD, 7.8 percentage points (95% CI: 5.7 to 10.0)] and non-Hispanic Asians were less likely [adjusted PD, -13.7 percentage points (95% CI: -22.3 to -5.0)] to have ≥1 diagnosed comorbidity after adjusting for age differences. There were no meaningful differences between non-Hispanic Whites and adults in other racial/ethnic groups. Those with low income were more likely to have ≥1 diagnosed comorbidity [PD, 7.3 percentage points (95% CI: 5.1 to 9.4)].

Conclusions: Among adults receiving HIV care, non-Hispanic Blacks and those with low income were more likely to have ≥1 diagnosed comorbidity associated with severe COVID-19. Building health equity among people with HIV during the COVID-19 pandemic may require reducing the impact of comorbidities in heavily affected communities.

FIGURE 1.

Sample disposition for this analysis, the Medical Monitoring Project, 2016–2018 data collection cycles.

FIGURE 2.

Prevalence difference of having ≥1 diagnosed comorbidities associated with severe COVID-19 among people receiving HIV care in the United States, 2014–2019, the Medical Monitoring Project, N = 4473. A, Race/ethnicity, adjusted for age, reference group is White, non-Hispanic adults. B, Income at or below the poverty threshold, unadjusted, reference is income above the poverty threshold. C, Type of health insurance, unadjusted, reference is any private insurance. D, Ryan White HIV/AIDS Program funding of the usual place of care (health care facility), unadjusted, reference is no funding. Dashed red line is the meaningful threshold of increased prevalence. Dashed blue line is the meaningful threshold of decreased prevalence. Solid black line is the null threshold. ^aUnstable estimate (coefficient of variation is ≥0.3, absolute confidence interval is ≥30, and/or relative confidence interval is >130%). ^bPoverty guidelines as defined by the Department of Health and Human Services: https://aspe.hhs.gov/frequently-askedquestions-related-poverty-guidelines- and-poverty. ^cParticipants could select more than 1 response for health insurance or coverage for medications. ^dAny RWHAP funding (parts A, B, C, D, or F).