Intersecting social determinants of health, multimorbidity and quality of life in people of Black ethnicities with HIV in South London: a mixed-methods study.
Luxsena Sukumaran, Lourdes Dominguez-Dominguez, Lisa Hamzah, Jia Liu, Heidi Lempp, Elena Nikiphorou, Caroline A Sabin, Frank A Post, Shema Tariq
{"title":"Intersecting social determinants of health, multimorbidity and quality of life in people of Black ethnicities with HIV in South London: a mixed-methods study.","authors":"Luxsena Sukumaran, Lourdes Dominguez-Dominguez, Lisa Hamzah, Jia Liu, Heidi Lempp, Elena Nikiphorou, Caroline A Sabin, Frank A Post, Shema Tariq","doi":"10.1097/QAD.0000000000004343","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Social determinants of health (SDoH) impact health outcomes and rarely exert their influence in isolation. We examined associations between SDoH patterns, multimorbidity, and quality of life (QoL) in people of Black ethnicities with HIV in England.</p><p><strong>Methods: </strong>This mixed-methods study comprised questionnaires, focus group discussions and semi-structured interviews with staff members from a community-based organisation. We used principal component analysis to identify patterns of SDoH and z-scores to describe the burden of each pattern. Associations between SDoH burden scores, multimorbidity and QoL (EQ-5D) were assessed using logistic regression, adjusting for sex and age.</p><p><strong>Results: </strong>Amongst 340 participants (median [interquartile range, IQR] age 52 [45-57] years, 54% female, 95% HIV RNA <200 copies/ml), we identified three SDoH patterns: Livelihood (food, employment and financial insecurity, loneliness and isolation), Shelter/Displacement (housing, migration and food insecurity) and Social Exclusion (discrimination, loneliness and isolation). An increase in SDoH z-scores was associated with higher odds of multimorbidity (Livelihood: aOR 2.09 [1.63-2.69], Shelter/Displacement: 1.41 [1.12-1.78], Social Exclusion: 1.78 [1.40-2.26]). Higher Livelihood and Social Exclusion z-scores correlated with all QoL domains (p<0.001), and Shelter/Displacement was associated with problems with usual activity (aOR 1.29 [1.04-1.61], p = 0.02) and pain/discomfort (1.29 [1.05-1.58], p = 0.02). Qualitative findings supported the quantitative findings whilst providing further context on how SDoH intersect and shape health.</p><p><strong>Conclusion: </strong>This study highlights how SDoH intersect and are associated with multimorbidity and lower QoL in people of Black ethnicities living with HIV. These findings emphasise the need for comprehensive, biopsychosocial interventions to address health inequities in this population.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"AIDS","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/QAD.0000000000004343","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Social determinants of health (SDoH) impact health outcomes and rarely exert their influence in isolation. We examined associations between SDoH patterns, multimorbidity, and quality of life (QoL) in people of Black ethnicities with HIV in England.
Methods: This mixed-methods study comprised questionnaires, focus group discussions and semi-structured interviews with staff members from a community-based organisation. We used principal component analysis to identify patterns of SDoH and z-scores to describe the burden of each pattern. Associations between SDoH burden scores, multimorbidity and QoL (EQ-5D) were assessed using logistic regression, adjusting for sex and age.
Results: Amongst 340 participants (median [interquartile range, IQR] age 52 [45-57] years, 54% female, 95% HIV RNA <200 copies/ml), we identified three SDoH patterns: Livelihood (food, employment and financial insecurity, loneliness and isolation), Shelter/Displacement (housing, migration and food insecurity) and Social Exclusion (discrimination, loneliness and isolation). An increase in SDoH z-scores was associated with higher odds of multimorbidity (Livelihood: aOR 2.09 [1.63-2.69], Shelter/Displacement: 1.41 [1.12-1.78], Social Exclusion: 1.78 [1.40-2.26]). Higher Livelihood and Social Exclusion z-scores correlated with all QoL domains (p<0.001), and Shelter/Displacement was associated with problems with usual activity (aOR 1.29 [1.04-1.61], p = 0.02) and pain/discomfort (1.29 [1.05-1.58], p = 0.02). Qualitative findings supported the quantitative findings whilst providing further context on how SDoH intersect and shape health.
Conclusion: This study highlights how SDoH intersect and are associated with multimorbidity and lower QoL in people of Black ethnicities living with HIV. These findings emphasise the need for comprehensive, biopsychosocial interventions to address health inequities in this population.
背景：健康的社会决定因素（SDoH）影响健康结果，很少孤立地发挥其影响。我们研究了英格兰黑人HIV感染者的SDoH模式、多发病和生活质量（QoL）之间的关系。方法：这个混合方法的研究包括问卷调查，焦点小组讨论和半结构化的采访工作人员来自一个社区组织。我们使用主成分分析来确定SDoH的模式和z分数来描述每种模式的负担。使用逻辑回归评估SDoH负担评分、多病和生活质量（EQ-5D）之间的关系，并对性别和年龄进行调整。结果：340名参与者（中位数[四分位数范围，IQR]年龄52[45-57]岁，54%女性，95% HIV RNA）结论：本研究强调了SDoH如何与黑人HIV感染者的多病和较低的生活质量相关。这些发现强调需要采取全面的生物心理社会干预措施来解决这一人群中的卫生不平等问题。
期刊介绍：
Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
