AIDS Stage, Race, Medicare Affect Hospital Rates in South Carolina

An AIDS diagnosis, AIDS stage, race, and access to Medicare (health insurance for the poor) strongly affected engagement in primary care and hospital admissions in a retrospective study of HIV-positive people in the US state of South Carolina.

Prompt linkage to primary care after HIV diagnosis is essential to effective care and may prevent trips to the hospital and HIV transmission. But fast referral to care remains a challenge in the United States and across the world.

This retrospective cohort study in South Carolina involved people diagnosed with HIV from January 1986 through December 2006 who used 62 inpatient facilities from January 2007 to June 2010. The researchers defined suboptimal primary care engagement as fewer than two CD4 count or viral load reports in each year from January 2007 through June 2010.
Statistical analysis determined that people who learned they had HIV when they went to the hospital with an AIDS illness were 58% more likely to have suboptimal HIV primary care engagement (adjusted odds ratio [aOR] 1.58, 95% confidence interval [CI] 1.23 to 2.04).
People diagnosed with HIV in the hospital were 74% more likely to have more subsequent hospital admissions (incidence rate ratio [IRR] 1.74, 95% CI 1.65 to 1.83) and twice as likely to spend more days in the hospital once admitted (IRR 2.17, 95% CI 2.00 to 2.36).
African Americans had greater odds of suboptimal care linkage than whites (aOR 1.61, 95% CI 1.15 to 2.25), more inpatient visits (IRR 1.09, 95% CI 1.01 to 1.17), and more inpatient days (IRR 1.21, 95% CI 1.09 to 1.34).
Having Medicare lowered chances of suboptimal primary care engagement (aOR 0.66, 95% CI 0.46 to 0.95) but was associated with more hospital admissions (IRR 1.09, 95% CI 1.01 to 1.18).
Having AIDS for 1 year or less cut the risk of suboptimal primary care engagement 95% (aOR 0.05, 95% CI 0.02 to 0.12), while having AIDS more than 1 year cut that risk almost 90% (aOR 0.11, 95% CI 0.06 to 0.20).
However, people with AIDS for 1 year or less were 12% more likely to have more hospital admissions (IRR 1.12, 95% CI 1.04 to 1.21), as were people with AIDS for more than 1 year (IRR 1.12, 95% CI 1.04 to 1.21).
Having AIDS 1 year or less made more inpatient days 22% more likely (IRR 1.22, 95% CI 1.08 to 1.37), while having AIDS more than 1 year made more inpatient days 35% more likely (IRR 1.35, 95% CI 1.21 to 1.50).
The researchers conclude that “disease stage, race, and insurance status strongly influence HIV primary care engagement and inpatient hospitalization.” They suggest that “admissions may be related to general medical conditions, substance abuse, or antiretroviral therapy.”
Source: Jelani C. Kerr, Terri G. Stephens, James J. Gibson, Wayne A. Duffus. Risk factors associated with inpatient hospital utilization in HIV-positive individuals and relationship to HIV care engagement. JAIDS. 2012; 60: 173-182.

For the study abstract (Downloading the complete article requires a subscription to JAIDS or an online payment; the abstract is free.)

Written by Mark Mascolini on behalf of the International AIDS Society