This population-based study assessed whether the period after COVID-19 vaccine availability was associated with differences in COVID-19 mortality risk across subgroups among 122,527 people with HIV (PWH) in Florida. The primary aim was to compare COVID-19–related mortality before vaccine availability with mortality during the period when vaccines were available, and to examine variation by race/ethnicity and area-level social vulnerability.
Investigators analyzed statewide HIV surveillance data for Florida, linking those records with ZIP code–level measures of the Social Vulnerability Index (SVI) and Rural-Urban Commuting Area Codes. The analytic cohort comprised 122,527 PWH identified in Florida surveillance data. The authors used a competing risks modeling approach to account for non–COVID-19 competing causes of death when estimating COVID-19 mortality hazards.
Two time windows were defined for comparison: a pre-vaccine period (March 1, 2020–April 30, 2021) and a vaccine availability period (May 1, 2021–December 31, 2021). The competing risks model compared COVID-19 mortality hazards across these intervals and estimated adjusted hazard ratios (HRs) for subgroup comparisons, including race/ethnicity and area-level social vulnerability. The study did not attempt to estimate the causal effect of individual vaccination uptake.
Aggregate COVID-19 mortality rates among PWH increased from the pre-vaccine to the vaccine-availability period. Reported rates rose from 22.3 per 100,000 person-months before vaccine availability to 27.5 per 100,000 person-months during vaccine availability. The authors attribute part of this increase to the Delta variant surge that occurred in mid-to-late 2021.
Adjusted hazard estimates revealed persistent disparities by race and ethnicity. Compared with Non-Hispanic White (NHW) PWH, Non-Hispanic Black (NHB) PWH had elevated adjusted COVID-19 mortality hazards both before vaccine availability (HR 2.06, 95% CI 1.45–2.91) and during vaccine availability (HR 1.60, 95% CI 1.13–2.27).
For Hispanic PWH, the relative hazard compared with NHW was elevated in the pre-vaccine period (HR 2.24, 95% CI 1.55–3.23) but attenuated during the vaccine-availability period (HR 1.03, 95% CI 0.68–1.57), indicating a change in relative risk across the two time windows.
Area-level social vulnerability, measured using the Social Vulnerability Index (SVI) at the ZIP code level, was associated with COVID-19 mortality during the vaccine-availability period. In the final adjusted model, living in ZIP code–level areas of high overall SVI (high vs. low) was associated with an elevated hazard of COVID-19 mortality during vaccine availability (HR 1.75, 95% CI 1.04–2.97). This finding highlights the role of place-based social vulnerability in observed mortality patterns.
Although overall COVID-19 mortality rates were higher during the period when vaccines were available, subgroup patterns varied considerably. Disparities persisted for NHB PWH across both time periods and were most pronounced among PWH residing in more socially vulnerable areas. The authors explicitly note that these observational comparisons do not provide estimates of the causal effect of vaccination uptake, and the study does not report individual-level vaccination status or causal inference regarding vaccines.
The reported increase in aggregate mortality during the vaccine-availability period was partly linked by the authors to the Delta variant surge in mid-to-late 2021, which affected COVID-19 epidemiology during that interval.
The authors conclude that tailored vaccination strategies and structural interventions remain essential to advance equity in the pandemic response for PWH. Given persistent racial/ethnic disparities and the association with area-level social vulnerability, interventions that address access, outreach, and structural determinants are emphasized as priorities to reduce inequities in COVID-19 outcomes among PWH.
All numeric results, hazard ratios, confidence intervals, period definitions, cohort size, and key findings are those reported by the authors in the source abstract. The full article may include additional methodological detail, subgroup analyses, or sensitivity checks not captured in the abstract. The authors declared no competing interests.