Abstract MP03: Social Adversities and Mortality in HIV and Heart Failure Patients: A Multi-Center Retrospective Cohort Study From Public Hospitals in New York City
Authors: Chen Yi-Yun , Borkowski Pawel , Nazarenko Natalia , Parker Matthew , Biavati Luca , Vargas-Pena Coral , Chowdhury Ishmum , Bock Joshua , Garg Vibhor , Mehta Adhya , Faillace Robert , Palaiodimos Leonidas 
Published: May 2024

Introduction:
Individuals living with HIV often face heightened social challenges, particularly in the context of heart failure, turning their chronic disease management into uphill battle. Yet, current literature provides limited insight into how social adversities impact the outcome of HIV heart failure population. This study aims to investigate the relationship between overall mortality and lifetime social adversities in patients diagnosed with HIV and heart failure.

Methods:
This study utilized data from the New York City Health + Hospitals HIV Heart Failure (NYC 4H) retrospective cohort, encompassing records from eleven major New York City Health + Hospitals. Patients were recruited from both inpatient and clinic hospital visits between 7/2017 and 6/2022. Those under the age of 18 and with baseline cancer were excluded from the study. Social adversities were meticulously assessed through licensed social workers' psychosocial assessment notes. The cohort was categorized into groups based on their number of exposures to social adversities (0, 1-2, >2). We evaluated the association between social adversities and overall mortality using hazard ratios (HR) employing Cox proportional hazards models. The analysis was adjusted for age, sex, race, co-morbidity, CD4 counts, HIV viral load, and activities of daily living (ADL).

Result:
The analysis included a total of 668 patients, comprising 400 males and 268 females. Over an average 4-year follow-up period, 112 deaths were identified. We found that 244 patients (36.5%) encountered at least one social adversity, and 125 patients (18.7%) faced more than one social adversity. After adjusting for covariates, exposure to any adversity was significantly associated with an 89% increase in risk for overall mortality compared to those without (HR 1.89, 95% Confidence Interval [CI] [1.23,2.90], p=0.004) during follow-up period. Patients exposed to one to two adversities had 1.57 times risk (HR 1.57, 95%CI [1.05,2.43], p=0.027) comparing to those without any social adversities. Patients who have more than two social adversities had 2.83 times overall mortality risk (HR 2.83, 95%CI [1.69,4.74], p<0.001) compared to those without. Particularly, significant associations were observed among individuals facing food deprivation (HR 3.58, p<0.001), lacking family support (HR 2.80, p<0.001), engaging in polysubstance abuse (HR 1.72, p<0.01), and suffering from mental illness (HR 1.64, p<0.05).

Conclusion:
Our study demonstrates a significant correlation between social adversities and higher mortality rates among HIV-related heart failure patients. Notably, factors such as food deprivation, lack of family support, polysubstance abuse, and mental illness emerged as pivotal contributors to this association, underscoring the need for comprehensive social evaluation and support within this vulnerable population.