Abstract TH910: Examining the Associations Between Social Vulnerability and Clinical and Behavioral Risk for Atherosclerotic Cardiovascular Disease among Women with HIV and Women without HIV

Abstract

Introduction: The Social Vulnerability Index (SVI) is used to assess area-level atherosclerotic cardiovascular disease (ASCVD) risk by identifying communities that are more susceptible to ASCVD due to exposure to adverse social and environmental factors and their associated behavioral and clinical risks. We sought to examine associations of overall SVI score and its thematic elements with clinical (hypertension, diabetes, and dyslipidemia) and behavior (smoking, substance, and heavy alcohol use) risk for ASCVD and estimated 10-year ASCVD risk, as calculated by the ACC/AHA Pooled Cohort Equation. Methods: Women with HIV (WWH) and women without HIV (WWoH) from the MACS/WIHS Combined Cohort Study were included if they were 30–79 years of age, had residential location data available, and attended a study visit between April and September 2019. Addresses were geocoded to 2019 census tract-level SVI. Analyses incorporated both the overall SVI score and its four thematic elements: socioeconomic status, household composition, racial and ethnic minority status, and housing type and transportation. Participants were grouped into tertiles by their SVI, with the third tertile representing those with higher relative vulnerability. Logistic regression models were used to examine the associations between participant tertiles for SVI and clinical and behavior risk factors for ASCVD and 10-year risk scores. Models were adjusted for HIV-status, age, race/ethnicity, employment, income, and insurance, except when modeling 10-year risk, age was removed as a covariate. Results: The analyses included 1699 women (72% WWH). The majority (88%) were virally suppressed. Clinical risk factors for ASCVD were prevalent [(hypertension (73%), diabetes (30%), dyslipidemia (54%)]. Few (<10%) reported substance use or heavy alcohol use and 40% reported smoking. Compared to women in the first SVI tertile, women in third tertile had higher odds of diabetes (OR=1.35, 95% CI: 1.02 – 1.77) and lower odds of substance use (OR=0.73, 95% CI: 0.46 – 1.16) and heavy alcohol use (OR=0.84, 95% CI: 0.55 – 1.27). Women in the third tertile for racial and ethnic minority status had lower odds of hypertension (OR=0.71, 95% CI: 0.53 – 0.94). No other notable associations were present between overall SVI or its thematic elements and behavioral or clinical risk for ASCVD. Conclusion: The SVI may be useful in examining and addressing the impact of area-level social vulnerability on ASCVD risk among WWH and WWoH.