Alcohol use and geriatric syndromes among specific minoritized groups living in socioeconomic disadvantage

Alcohol use is common among people with HIV (PWH) and can exacerbate HIV associated inflammaging (chronic inflammation and immune dysfunction), increasing the risk of debilitating geriatric syndromes among PWH. The etiology of both HIV and alcohol use underscores the important role of syndemic social risk factors in determining health outcomes - particularly for those living in socio-economically disadvantaged communities. Best practices suggest that studies aimed at understanding adverse health outcomes born from syndemic risks should center on communities of interest and investigate structural determinants that shape their experiences. Using best practices, we propose to understand associations between alcohol use and key geriatric syndrome outcomes for people with HIV, and to investigate whether neighborhood socioeconomic disadvantage—a composite structural determinant of health representing multiple facets of access to resources—moderates these relationships. Specifically, we will determine associations of unhealthy alcohol use with falls, fractures, delirium, dementia, physiologic frailty and mortality (Aims 1 and 2) among people with HIV, and evaluate whether associations in Aims 1 and 2 vary based on neighborhood socioeconomic disadvantage (Aim 3). We will evaluate all aims in the Veterans Aging Cohort Study (VACS), both overall and secondarily within and between subgroups. We hypothesize that alcohol use has greater impact on geriatric syndromes among people with HIV, with greater risk among those living in areas with greater socioeconomic disadvantage. Our findings will also be independently validated in two outside cohorts. This research will be conducted by a team with a strong collaborative history with expertise in health services research, HIV, addiction medicine, geriatric syndromes, and alcohol research. This proposal is innovative given its focus on understanding the role that multilevel, intersecting factors have on geriatric syndromes among PWH within key understudied and disproportionately impacted subgroups. These data have potential to be of high impact as they will identify the role of potentially modifiable targets on geriatric syndromes and generate data on who to prioritize for practice and policy intervention.