Context Matters: Mapping Social Determinants of Health and Physical Function in Older People with HIV Using...

Area of Science:

• Gerontology
• Public Health
• HIV Medicine

Background:

• Older adults living with HIV (PWH) exhibit accelerated physical function decline and frailty compared to their HIV-negative counterparts.
• Sedentary lifestyles exacerbate functional limitations in this population.
• Geolocated social determinants of health (SDOH) are increasingly recognized as critical factors influencing health outcomes.

Purpose of the Study:

• To investigate the association between geolocated SDOH and physical function measures in older, sedentary PWH.
• To compare these associations across two distinct geographic locations (Colorado and Washington).

Main Methods:

• Cross-sectional analysis of baseline data from 120 sedentary PWH (aged ≥50 years) enrolled in the HEALTH randomized exercise trial.
• Residential addresses were used to derive geolocated SDOH, including neighborhood socioeconomic status, mobility infrastructure, environmental amenities/hazards, and healthcare access.
• Physical function was assessed using measures like 400-m walk time, chair rise time, PROMIS function, daily steps, and frailty status.
• Spearman's correlations were employed to analyze associations between SDOH and physical function indicators.

Main Results:

• In Colorado, higher Area Deprivation Index (ADI) correlated with slower chair rise times.
• In Washington, increased Social Vulnerability Index (SVI) was linked to slower 400-m walk times, and greater distance to parks was noted in pre-frail/frail individuals.
• Pooled analysis indicated that pre-frail/frail PWH lived in neighborhoods with higher SVI scores.
• Higher neighborhood deprivation, social vulnerability, and park proximity were associated with poorer physical function, with regional variations observed.

Conclusions:

• Neighborhood context, encompassing deprivation and social vulnerability, significantly influences physical function in older PWH.
• Geolocated SDOH, including park accessibility, are critical factors affecting mobility and frailty in this population.
• Findings underscore the importance of place-based interventions to address functional disparities among older PWH and suggest the need for larger, prospective studies.