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Association of Neighborhood Deprivation With Healthcare Utilization Among Persons With Human Immunodeficiency Virus: A Latent Class Analysis

BACKGROUND: We previously identified 3 latent classes of healthcare utilization among people with human immunodeficiency virus (PWH): adherent, nonadherent, and sick. Although membership in the “nonadherent” group was associated with subsequent disengagement from human immunodeficiency virus (HIV) c...

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Autores principales: Montano-Campos, J Felipe, Stout, Jason E, Pettit, April C, Okeke, Nwora Lance
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10326676/
https://www.ncbi.nlm.nih.gov/pubmed/37426949
http://dx.doi.org/10.1093/ofid/ofad317
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author Montano-Campos, J Felipe
Stout, Jason E
Pettit, April C
Okeke, Nwora Lance
author_facet Montano-Campos, J Felipe
Stout, Jason E
Pettit, April C
Okeke, Nwora Lance
author_sort Montano-Campos, J Felipe
collection PubMed
description BACKGROUND: We previously identified 3 latent classes of healthcare utilization among people with human immunodeficiency virus (PWH): adherent, nonadherent, and sick. Although membership in the “nonadherent” group was associated with subsequent disengagement from human immunodeficiency virus (HIV) care, socioeconomic predictors of class membership remain unexplored. METHODS: We validated our healthcare utilization–based latent class model of PWH receiving care at Duke University (Durham, North Carolina) using patient-level data from 2015 to 2018. SDI scores were assigned to cohort members based on residential addresses. Associations of patient-level covariates with class membership were estimated using multivariable logistic regression and movement between classes was estimated using latent transition analysis. RESULTS: A total of 1443 unique patients (median age of 50 years, 28% female sex at birth, 57% Black) were included in the analysis. PWH in the most disadvantaged (highest) SDI decile were more likely to be in the “nonadherent” class than the remainder of the cohort (odds ratio [OR], 1.58 [95% confidence interval {CI}, .95–2.63]) and were significantly more likely to be in the “sick” class (OR, 2.65 [95% CI, 2.13–3.30]). PWH in the highest SDI decile were also more likely to transition into and less likely to transition out of the “sick” class. CONCLUSIONS: PWH who resided in neighborhoods with high levels of social deprivation were more likely to have latent class membership in suboptimal healthcare utilization groupings, and membership persisted over time. Risk stratification models based on healthcare utilization may be useful tools in the early identification of persons at risk for suboptimal HIV care engagement.
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spelling pubmed-103266762023-07-08 Association of Neighborhood Deprivation With Healthcare Utilization Among Persons With Human Immunodeficiency Virus: A Latent Class Analysis Montano-Campos, J Felipe Stout, Jason E Pettit, April C Okeke, Nwora Lance Open Forum Infect Dis Major Article BACKGROUND: We previously identified 3 latent classes of healthcare utilization among people with human immunodeficiency virus (PWH): adherent, nonadherent, and sick. Although membership in the “nonadherent” group was associated with subsequent disengagement from human immunodeficiency virus (HIV) care, socioeconomic predictors of class membership remain unexplored. METHODS: We validated our healthcare utilization–based latent class model of PWH receiving care at Duke University (Durham, North Carolina) using patient-level data from 2015 to 2018. SDI scores were assigned to cohort members based on residential addresses. Associations of patient-level covariates with class membership were estimated using multivariable logistic regression and movement between classes was estimated using latent transition analysis. RESULTS: A total of 1443 unique patients (median age of 50 years, 28% female sex at birth, 57% Black) were included in the analysis. PWH in the most disadvantaged (highest) SDI decile were more likely to be in the “nonadherent” class than the remainder of the cohort (odds ratio [OR], 1.58 [95% confidence interval {CI}, .95–2.63]) and were significantly more likely to be in the “sick” class (OR, 2.65 [95% CI, 2.13–3.30]). PWH in the highest SDI decile were also more likely to transition into and less likely to transition out of the “sick” class. CONCLUSIONS: PWH who resided in neighborhoods with high levels of social deprivation were more likely to have latent class membership in suboptimal healthcare utilization groupings, and membership persisted over time. Risk stratification models based on healthcare utilization may be useful tools in the early identification of persons at risk for suboptimal HIV care engagement. Oxford University Press 2023-06-13 /pmc/articles/PMC10326676/ /pubmed/37426949 http://dx.doi.org/10.1093/ofid/ofad317 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Article
Montano-Campos, J Felipe
Stout, Jason E
Pettit, April C
Okeke, Nwora Lance
Association of Neighborhood Deprivation With Healthcare Utilization Among Persons With Human Immunodeficiency Virus: A Latent Class Analysis
title Association of Neighborhood Deprivation With Healthcare Utilization Among Persons With Human Immunodeficiency Virus: A Latent Class Analysis
title_full Association of Neighborhood Deprivation With Healthcare Utilization Among Persons With Human Immunodeficiency Virus: A Latent Class Analysis
title_fullStr Association of Neighborhood Deprivation With Healthcare Utilization Among Persons With Human Immunodeficiency Virus: A Latent Class Analysis
title_full_unstemmed Association of Neighborhood Deprivation With Healthcare Utilization Among Persons With Human Immunodeficiency Virus: A Latent Class Analysis
title_short Association of Neighborhood Deprivation With Healthcare Utilization Among Persons With Human Immunodeficiency Virus: A Latent Class Analysis
title_sort association of neighborhood deprivation with healthcare utilization among persons with human immunodeficiency virus: a latent class analysis
topic Major Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10326676/
https://www.ncbi.nlm.nih.gov/pubmed/37426949
http://dx.doi.org/10.1093/ofid/ofad317
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