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Cardiology Encounters for Underrepresented Racial and Ethnic Groups with Human Immunodeficiency Virus and Borderline
Gerald S Bloomfield1,2, C Larry Hill3, Karen Chiswell3
1Department of Medicine, Duke University School of Medicine, Durham, NC, USA. gerald.bloomfield@duke.edu.
Insights
Underrepresented racial and ethnic groups with HIV and borderline cardiovascular disease risk are less likely to see a cardiologist. Key factors influencing cardiology encounters include insurance, urban residence, and diagnosed cardiovascular disease.
Area of Science:
- Cardiology
- Infectious Diseases
- Health Disparities
Background:
- Underrepresented racial and ethnic groups (UREGs) with HIV face higher cardiovascular disease (CVD) risk.
- Cardiovascular specialist referral improves CVD risk management in high-risk individuals.
- Factors influencing cardiology encounters for UREGs with HIV are not well understood.
Purpose of the Study:
- To identify patient and provider factors associated with cardiology encounters in UREGs with HIV and borderline CVD risk.
Main Methods:
- A cohort of 2,039 UREGs with HIV and borderline CVD risk (2014-2020) was analyzed.
- Cox proportional hazards regression assessed associations with cardiology encounters.
- Data were collected from four U.S. academic medical centers.
Main Results:
- 14% of participants had an ambulatory cardiology visit.
- Women were more likely to have a cardiology encounter than men (17% vs. 11%).
- Older age, higher BMI, atrial fibrillation, multimorbidity, urban residence, and lack of insurance were linked to increased cardiology encounters.
Conclusions:
- Diagnosed CVD, insurance type, and urban residence were strongest predictors of cardiology encounters.
- Further research is needed to understand the impact of these encounters on CVD care and outcomes in this population.
Background:
Underrepresented racial and ethnic groups (UREGs) with HIV have a higher risk of cardiovascular disease (CVD) compared with the general population. Referral to a cardiovascular specialist improves CVD risk factor management in high-risk individuals. However, patient and provider factors impacting the likelihood of UREGs with HIV to have an encounter with a cardiologist are unknown.
Methods:
We evaluated a cohort of UREGs with HIV and borderline CVD risk (10-year risk ≥ 5% by the pooled cohort equations or ≥ 7.5% by Framingham risk score). Participants received HIV-related care from 2014-2020 at four academic medical centers in the United States (U.S.). Adjusted Cox proportional hazards regression was used to estimate the association of patient and provider characteristics with time to first ambulatory cardiology encounter.
Results:
A total of 2,039 people with HIV (PWH) and borderline CVD risk were identified. The median age was 45 years (IQR: 36-50); 52% were female; and 94% were Black. Of these participants, 283 (14%) had an ambulatory visit with a cardiologist (17% of women vs. 11% of men, p < .001). In fully adjusted models, older age, higher body mass index (BMI), atrial fibrillation, multimorbidity, urban residence, and no recent insurance were associated with a greater likelihood of an encounter with a cardiologist.
Conclusion:
In UREGs with HIV and borderline CVD risk, the strongest determinants of a cardiology encounter were diagnosed CVD, insurance type, and urban residence. Future research is needed to determine the extent to which these encounters impact CVD care practices and outcomes in this population.
Trial Registration:
ClinicalTrials.gov Identifier: NCT04025125.
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