Document Detail

Risk Factors Associated with Inpatient Hospital Utilization in HIV-positive Individuals and Relationship to HIV Care Engagement.
MedLine Citation:
PMID:  22293549     Owner:  NLM     Status:  Publisher    
BACKGROUND: Prompt linkage to HIV primary care may reduce the need for inpatient hospitalization. METHODS: Retrospective cohort study of South Carolina HIV-infected individuals diagnosed from January 1986-December 2006 who utilized 62 inpatient facilities from (January 2007-June 2010). Suboptimal primary care engagement was defined as <2 reports of a CD4T-cell count or viral load value to surveillance in each calendar year from January 2007-June 2010. Multivariable logistic regression explored associations of HIV primary care engagement with inpatient hospitalization after accounting for socio-demographic characteristics and disease stage. Poisson and negative binominal regression examined primary care engagement, socio-demographic characteristics, and disease stage on frequency of inpatient hospitalization and total inpatient days. RESULTS: Individuals presenting to the hospital with an AIDS-defining illness had greater risk of suboptimal HIV primary care engagement (aOR=1.58; 95%CI=1.23-2.04) more inpatient hospitalizations (IRR=1.74; 95%CI=1.65-1.83) and inpatient days (IRR=2.17; 95%CI=2.00-2.36). Blacks demonstrated greater suboptimal care risk (aOR=1.61; 95%CI=1.15-2.25) more inpatient visits (IRR=1.09; 95%CI=1.01-1.17), and inpatient days (IRR=1.21; 95%CI=1.09-1.34). Medicare protected against suboptimal primary care engagement (aOR=0.66; 95%CI=0.46-0.95) but was associated with more hospitalizations (IRR=1.09; 95%CI=1.01-1.18). AIDS disease stage was associated with decreased suboptimal care risk (AIDS ≤1 year, aOR=0.05; 95%CI=0.02-0.12; AIDS >1 year, aOR=0.11; 95%CI=0.06-0.20) but more hospitalizations (AIDS ≤1 year, IRR=1.12; 95%CI=1.04-1.21; AIDS >1 year, IRR=1.12; 95%CI=1.04-1.21) and inpatient days (AIDS ≤1 year, IRR=1.22; 95%CI=1.08-1.37; AIDS >1 year, IRR=1.35; 95%CI=1.21-1.50). CONCLUSIONS: Disease stage, race and insurance status strongly influence HIV primary care engagement and inpatient hospitalization. Admissions may be related to general medical conditions, substance abuse, or antiretroviral therapy.
Jelani Kerr; Terri Stephens; James Jerry Gibson; Wayne A Duffus
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-30
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  -     ISSN:  1944-7884     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-2-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1South Carolina Department of Health and Environmental Control, Bureau of Disease Control, 1751 Calhoun Street, Columbia, SC 2920 2University of South Carolina School Of Medicine, Department of Medicine, Division of Infectious Diseases, Two Medical Park, Columbia, SC 29203 3Centre for Research on Inner City Health, St Michael's Hospital, 209 Victoria St, Toronto, ON M5C 18W.
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