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

Older people with HIV (PWH) experience higher rates of physical function decline and frailty than those without HIV. This study aimed to examine the association between physical function measures and geolocated social determinants of health (SDOH) in two geographically distinct groups of older sedentary PWH. We conducted a cross-sectional analysis using baseline data from a randomized exercise trial (the High-Intensity Exercise Study to Attenuate Limitations and Train Habits in Older Adults with HIV; HEALTH) of 120 sedentary PWH aged ≥ 50 years from two sites (Aurora/Denver, Colorado [CO], and Seattle, Washington [WA]). Geolocated SDOH (neighborhood socioeconomic status, mobility infrastructure, environmental amenities and hazards, and access to healthcare) were derived from residential addresses and linked with physical function indicators (400-m walk time, chair rise time, PROMIS function, steps per day, and frailty). Spearman's correlations were used to quantify the associations between the study variables. For CO, a higher Area Deprivation Index (ADI) was significantly associated with slower chair rise times. In WA, a higher Social Vulnerability Index (SVI) correlated with slower 400-m walk times, and a greater distance to parks was observed among pre-frail/frail participants. Pooled analyses revealed that participants classified as pre-frail/frail resided in neighborhoods with significantly higher SVI scores. Higher neighborhood deprivation, greater social vulnerability, and increased distance to parks were significantly associated with poorer physical function, with site-specific patterns. These findings suggest that the neighborhood context may influence functional health and highlight the need for larger studies to inform place-based interventions.