TY - JOUR
T1 - The Intersections of COVID-19, HIV, and Race/Ethnicity
T2 - Machine Learning Methods to Identify and Model Risk Factors for Severe COVID-19 in a Large U.S. National Dataset
AU - The National COVID Cohort Collaborative (N3C) Consortium
AU - Kunz, Miranda
AU - Rott, Kollin W.
AU - Hurwitz, Eric
AU - Kunisaki, Ken
AU - Sun, Jing
AU - Wilkins, Kenneth J.
AU - Islam, Jessica Y.
AU - Patel, Rena
AU - Safo, Sandra E.
AU - Zhang, Xiaohan Tanner
AU - Hillegass, William
AU - Cooper, Will
AU - Beasley, Will
AU - Hernandez, Wenndy
AU - Kibbe, Warren A.
AU - Subbian, Vignesh
AU - Gordon, Valery
AU - Sheikh, Usman
AU - Topaloglu, Umit
AU - Callahan, Tiffany
AU - Bennett, Tellen D.
AU - Johnson, Steve
AU - Hong, Stephanie S.
AU - Setoguchi, Soko
AU - O’Neil, Shawn T.
AU - Chapman, Scott
AU - Vedula, Satyanarayana
AU - Mallipattu, Sandeep
AU - Bozzette, Samuel
AU - Michael, Sam G.
AU - Pyarajan, Saiju
AU - Miller, Robert T.
AU - Hurley, Robert
AU - Kamaleswaran, Rishi
AU - Zhu, Richard L.
AU - Moffitt, Richard A.
AU - Erwin-Cohen, Rebecca
AU - Jawa, Randeep
AU - Fuentes, Rafael
AU - Payne, Philip R.O.
AU - Robinson, Peter
AU - Burgoon, Penny Wung
AU - Francis, Patricia A.
AU - Sadan, Ofer
AU - Sharafeldin, Noha
AU - Garbarini, Nicole
AU - Safdar, Nasia
AU - Qureshi, Nabeel
AU - Morris, Michele
AU - Kurilla, Michael G.
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024.
PY - 2024/10
Y1 - 2024/10
N2 - We investigate risk factors for severe COVID-19 in persons living with HIV (PWH), including among racialized PWH, using the U.S. population-sampled National COVID Cohort Collaborative (N3C) data released from January 1, 2020 to October 10, 2022. We defined severe COVID-19 as hospitalized with invasive mechanical ventilation, extracorporeal membrane oxygenation, discharge to hospice or death. We used machine learning methods to identify highly ranked, uncorrelated factors predicting severe COVID-19, and used multivariable logistic regression models to assess the associations of these variables with severe COVID-19 in several models, including race-stratified models. There were 3 241 627 individuals with incident COVID-19 cases and 81 549 (2.5%) with severe COVID-19, of which 17 445 incident COVID-19 and 1 020 (5.8%) severe cases were among PWH. The top highly ranked factors of severe COVID-19 were age, congestive heart failure (CHF), dementia, renal disease, sodium concentration, smoking status, and sex. Among PWH, age and sodium concentration were important predictors of COVID-19 severity, and the effect of sodium concentration was more pronounced in Hispanics (aOR 4.11 compared to aOR range: 1.47–1.88 for Black, White, and Other non-Hispanics). Dementia, CHF, and renal disease was associated with higher odds of severe COVID-19 among Black, Hispanic, and Other non-Hispanics PWH, respectively. Our findings suggest that the impact of factors, especially clinical comorbidities, predictive of severe COVID-19 among PWH varies by racialized groups, highlighting a need to account for race and comorbidity burden when assessing the risk of PWH developing severe COVID-19.
AB - We investigate risk factors for severe COVID-19 in persons living with HIV (PWH), including among racialized PWH, using the U.S. population-sampled National COVID Cohort Collaborative (N3C) data released from January 1, 2020 to October 10, 2022. We defined severe COVID-19 as hospitalized with invasive mechanical ventilation, extracorporeal membrane oxygenation, discharge to hospice or death. We used machine learning methods to identify highly ranked, uncorrelated factors predicting severe COVID-19, and used multivariable logistic regression models to assess the associations of these variables with severe COVID-19 in several models, including race-stratified models. There were 3 241 627 individuals with incident COVID-19 cases and 81 549 (2.5%) with severe COVID-19, of which 17 445 incident COVID-19 and 1 020 (5.8%) severe cases were among PWH. The top highly ranked factors of severe COVID-19 were age, congestive heart failure (CHF), dementia, renal disease, sodium concentration, smoking status, and sex. Among PWH, age and sodium concentration were important predictors of COVID-19 severity, and the effect of sodium concentration was more pronounced in Hispanics (aOR 4.11 compared to aOR range: 1.47–1.88 for Black, White, and Other non-Hispanics). Dementia, CHF, and renal disease was associated with higher odds of severe COVID-19 among Black, Hispanic, and Other non-Hispanics PWH, respectively. Our findings suggest that the impact of factors, especially clinical comorbidities, predictive of severe COVID-19 among PWH varies by racialized groups, highlighting a need to account for race and comorbidity burden when assessing the risk of PWH developing severe COVID-19.
KW - COVID-19
KW - Comorbidities in HIV
KW - Persons with HIV
KW - Racialized groups
UR - http://www.scopus.com/inward/record.url?scp=85184173938&partnerID=8YFLogxK
U2 - 10.1007/s10461-024-04266-6
DO - 10.1007/s10461-024-04266-6
M3 - Article
C2 - 38326668
AN - SCOPUS:85184173938
SN - 1090-7165
VL - 28
SP - 5
EP - 21
JO - AIDS and Behavior
JF - AIDS and Behavior
IS - Suppl 1
ER -