Fleishman John A, Hellinger Fred H
Center for Cost and Financing Studies, Agency For Healthcare Research and Quality, Rockville, Maryland 20850, USA.
J Acquir Immune Defic Syndr. 2003 Sep 1;34(1):102-10. doi: 10.1097/00126334-200309010-00015.
HIV-related inpatient utilization declined immediately after the diffusion of highly active antiretroviral therapy (HAART), but some studies suggest that admission rates may have recently begun to increase. Using comprehensive hospital discharge data from 7 states, this study examines trends in HIV-related inpatient admissions and length of stay (LOS) from 1996 through 2000.
We identified HIV-related admissions by ICD-9-CM diagnosis codes in the range from 042 to 044. Analyses assessed differential patterns of change over time, depending on state, gender, race/ethnicity, and insurance.
HIV-related inpatient admissions generally declined each year, but the rate of decline diminished recently. A similar pattern held for trends in inpatient LOS. Admissions for white male patients and for patients with private insurance showed the greatest decreases and the least leveling of the trend. The proportion of HIV admissions to total admissions was highest for black men and lowest for white women. In contrast to the period from 1993 through 1996, the proportion of HIV admissions covered by Medicare was greater than the rate of privately insured admissions.
Although there is no substantial evidence for widespread increases in admissions during this period, results suggest that the trend in HIV-related hospital admissions is level in recent years. Racial/ethnic disparities in inpatient utilization persist. Further analysis of the impact of treatment failure or HAART-related complications on HIV admissions is warranted.
高效抗逆转录病毒疗法（HAART）普及后，与HIV相关的住院率随即下降，但一些研究表明，住院率近期可能已开始上升。本研究利用来自7个州的综合医院出院数据，调查了1996年至2000年与HIV相关的住院人数及住院时长（LOS）的趋势。
我们通过ICD - 9 - CM诊断编码（范围为042至044）确定与HIV相关的住院病例。分析根据州、性别、种族/民族和保险情况评估随时间变化的差异模式。
与HIV相关的住院人数总体上逐年下降，但近期下降速度有所减缓。住院时长的趋势也呈现类似模式。白人男性患者和有私人保险的患者的住院人数下降幅度最大，且趋势最平缓。黑人男性的HIV住院人数占总住院人数的比例最高，白人女性最低。与1993年至1996年期间相比，医疗保险覆盖的HIV住院人数比例高于私人保险覆盖的住院人数比例。
尽管在此期间没有大量证据表明住院人数普遍增加，但结果表明近年来与HIV相关的住院趋势趋于平稳。住院利用率的种族/民族差异依然存在。有必要进一步分析治疗失败或HAART相关并发症对HIV住院人数的影响。
