Heart failure treatment across race.

BackgroundRacial disparities, an imbalance between the treatment of racial groups, in healthcare significantly affect the prognosis and treatment outcomes for people living with HIV (PLHIV) and heart failure (HF). The complexity of racial disparities in health care is exacerbated when social determinants of health (SDoH). Utilizing the New York City Health and Hospitals HIV Heart Failure (NYC 4H) cohort, one of the largest public health providers in New York City, this study aims to describe the epidemiological characteristics, treatment, and mortality differences among various racial groups in patients living with HIV (PLHIV) and HF.MethodsThis study utilized data from the mixed retrospective and prospective NYC 4H cohort, comprised of adult individuals with confirmed HIV and HF from inpatient or clinic visits between July 2017 and June 2022.from eleven major New York City Health and Hospitals. Racial identification was reported by the patients. Social adversities (SA) were assessed through a psychosocial evaluation conducted by licensed clinical social workers (LCSWs) during the initial clinic or hospital encounter within the enrollment period. Each patient’s home address was mapped to the area deprivation index (ADI) to obtain ADI ranking and further characterize socioeconomic disadvantage. We assessed the relationship between social adversities and overall mortality in each racial group using hazard ratios (HRs) derived from proportional hazard regression models.ResultsIn total, 1044 patients, including 631 Black/African American, 289 Hispanic/Latino, 57 non-Hispanic White, 17 Asian/Pacific Islander, and 50 of unknown or other racial backgrounds were analyzed in the study. An average follow-up time is 3.8 years. Significant racial difference in ischemic cardiomyopathy, with the highest occurrence found in the Black/African American group (51%) were noticed comparing to Asian/Pacific Islander (2.3%) and Other/Unknown groups (5.6%) (P . Non-Hispanic White group exhibited a higher prevalence of LGBTQ individuals at 10.5%, a identity not commonly listed among the top challenge for other racial groups (P = 0.002). During the follow-up period, a total of 259 deaths were recorded. The mortality rate is lowest in Asian/Pacific Islanders (11.8%), while comparing to non-Hispanic Whites (33.3%) and unknown or other races (50%).ConclusionsSignificant differences exist in comorbidities, disease management, and social conditions among HIV and heart failure patients across five racial groups. The findings suggest that within impoverished multiethnic communities, it is crucial to conduct comprehensive screenings for social adversities across all racial groups, as social disadvantage may manifest in various ways.

背景 医疗保健领域的种族差异——即不同种族群体间的诊疗待遇失衡——会显著影响艾滋病毒感染者（People Living with HIV，PLHIV）与心力衰竭（Heart Failure，HF）患者的预后及治疗结局。当纳入健康社会决定因素（Social Determinants of Health，SDoH）的影响时，医疗保健种族差异的复杂性会进一步加剧。本研究依托纽约市规模最大的公共卫生服务机构之一的纽约市健康与医院系统艾滋病毒心力衰竭（NYC 4H）队列，旨在描述同时罹患艾滋病毒感染与心力衰竭的不同种族群体患者的流行病学特征、诊疗情况及死亡率差异。

方法 本研究使用回顾性与前瞻性结合的NYC 4H队列数据，该队列纳入2017年7月至2022年6月期间，经住院或门诊就诊确诊为艾滋病毒感染与心力衰竭的成年个体，数据来自纽约市11家主要的健康与医院分支机构。患者自行申报种族身份。社会逆境（Social Adversities，SA）通过持牌临床社会工作者（Licensed Clinical Social Workers，LCSWs）在入组期间的首次门诊或住院接诊时开展的社会心理评估进行评定。本研究将每位患者的家庭住址映射至区域贫困指数（Area Deprivation Index，ADI）以获取ADI排名，进一步刻画其社会经济劣势水平。采用比例风险回归模型得到的风险比（Hazard Ratios，HRs），分析不同种族群体中社会逆境与全因死亡率之间的关联。

结果 本研究共纳入1044例患者进行分析，其中非裔美国人（Black/African American）631例、西班牙裔/拉丁裔（Hispanic/Latino）289例、非西班牙裔白人（non-Hispanic White）57例、亚裔/太平洋岛民（Asian/Pacific Islander）17例，以及种族背景未知或其他种族50例。平均随访时长为3.8年。研究观察到缺血性心肌病的发生率存在显著种族差异：非裔美国人组发生率最高，达51%，显著高于亚裔/太平洋岛民组的2.3%与其他/未知种族组的5.6%（P值未完整标注）。非西班牙裔白人组的LGBTQ群体占比为10.5%，显著高于其他种族群体（P=0.002），该身份标识在其他种族群体中并非常见的首要挑战。随访期间共记录259例死亡事件，亚裔/太平洋岛民组死亡率最低（11.8%），对比非西班牙裔白人组（33.3%）与未知或其他种族组（50%）。

结论 五大种族群体的艾滋病毒感染与心力衰竭患者在合并症、疾病管理及社会处境方面均存在显著差异。本研究结果提示，在多族裔贫困社区中，对所有种族群体开展社会逆境的全面筛查至关重要，因为社会劣势的表现形式存在多样性。