Intersecting social determinants of health, multimorbidity and quality of life in people of Black ethnicities with HIV in South London.

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 organization. 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% women, 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: adjusted odds ratio (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 emphasize the need for comprehensive, biopsychosocial interventions to address health inequities in this population.