Methods: We used national VHA data from 2013 to create a cohort of 25,676 Veterans in care for HIV. We quantified viral control (i.e. last serum HIV RNA ≤ 200 copies/ml among Veterans on cART), HTN control (i.e. last blood pressure ‹ 140/90mmHg among Veterans with HIV and HTN), and DM control (i.e. last hemoglobin A1C ‹ 9% among Veterans with HIV and DM). We used multivariable logistic regression to determine associations between these measures and race, after adjusting for age, sex, other comorbidities, nadir CD4 cell count, residential ZIP-code level poverty rates from census data, and retention in care (i.e. ≥ 2 clinic visits in year at least 60 days apart).
Results: Approximately half (50.1%) of the cohort was black, 43.7% were white, and 6.2% were of other or unknown race. Most received cART (N=23,444, 91.3%); while 9,854 (38.4%) had a HTN diagnosis; and 4,294 (16.7%) had a DM diagnosis. Blacks were less likely than whites to experience viral control (81.7% vs. 89.7%, p=<.0001), HTN control (73.8% VS. 79.1%, p=<.0001), and DM control (94.8% vs 96.8%, p=<.0001). Racial differences persisted in multivariable models (multivariable odds ratio for blacks referent to whites 0.65 [95% CI 0.59-0.72] for viral control, 0.77 [0.70-0.85] for BP control, and 0.79 [0.63-0.99] for DM control).
Conclusion: Even in an equal-access health care system with minimal barriers to care related to health insurance or co-pays, racial disparities existed in HIV care. Disparities extended to common comorbidities. Efforts to reduce racial disparities in HIV care should examine comprehensive measures for comorbidity control, as well as viral control.
D. Mcinnes, None
V. Yakochenko, None
L. Okwara, None
A. Midboe, None
B. Bokhour, None
M. Ohl, None