Building upon Ms. Rusie and Dr. Beach’s prior TC-CFAR funded EHE Planning Award and Dr. Beach’s TC-CFAR K12 award, our team from Northwestern and Howard Brown Health (HBH) propose to add data elements describing traditional CVD risk factors (e.g., diabetes, hypertension, smoking status, cholesterol levels, BMI), CVD, and HF, to a prior HBH EMR dataset containing information about HIV testing, HIV medications, HIV viral load, CD4 count, dates of office visits and lab work, sexual identity, sexual behavior, gender identity, sex at birth, race/ethnicity, mental health, socioeconomic status, health insurance status, and housing status. The generation of the proposed expanded EMR dataset from HBH will allow our team to investigate among people with HIV (PWH) if CVD risk factors, CVD burden, and HF burden vary by sexual orientation and gender identity at the intersections of race/ethnicity, housing status, SES, ART history, and HIV-related risk factors. Findings from these studies will be compared with parallel studies conducted in the Northwestern EMR led by Drs. Beach and Feinstein to investigate how HIV-related comorbidities vary across clinical contexts. Taken together, results from these studies will support a future R01 application investigating how SDoH ‘get under the skin’ to shape HIV- and CVD-related risk factors and co-morbidities among PWH, with the aim of improving the quality of CVD-related care received by multiply minoritized populations.

Specific Aim: 

Aim 1: Among PWH, characterize SDoH and CVD comorbidity burden and investigate associations between SDoH (housing status, SES, insurance, minoritization due to SO, GI, race/ethnicity), traditional CVD risk factors, HIV-related CVD risk factors, ART history, and HF. 

Hypothesis 1: Individuals who are minoritized on the basis of SO, GI, and/or race/ethnicity will be more likely to have greater vulnerability in other SDoH domains (e.g., homelessness, low SES, lack of health insurance).

Hypothesis 2: Individuals who are minoritized on the basis of SO, GI, and/or race/ethnicity will have a greater burden of traditional CVD risk factors, HIV-related CVD risk factors, and HF than their non-minoritized peers.

Hypothesis 3: Even after adjusting for ART history and traditional CVD and HIV-related HF risk factors, adjusting for SDoH will explain excess risk in CVD and HF among PWH.

Approach: CADENCES HIV HBH proposes one aim to characterize among PWH how SDoH contribute to traditional CVD risk factors, HIV-related risk factors, and ultimately excess CVD and HF risk. To accomplish this aim, the HBH team will add detailed EMR data elements documenting traditional CVD risk factors, CVD medications, CVD labs, and CVD-related diagnosis (including HF and HFpEF) to a HBH EMR dataset containing detailed SDoH and HIV-related information for 9,000 PWH engaged in care at HBH between January 1, 2012 and December 19, 2019. The resulting combined analytic dataset will be used to carry out all study hypotheses.