Kourtis Athena P, Bansil Pooja, Johnson Christopher, Meikle Susan F, Posner Samuel F, Jamieson Denise J
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Pediatr Infect Dis J. 2007 May;26(5):406-10. doi: 10.1097/01.inf.0000259953.79654.d0.
The purpose of this study was to describe hospital use patterns of children with sickle cell disease (SCD) and human immunodeficiency virus type-1 (HIV) infection in the United States.
Hospital discharges of children with 1 or both of the 2 conditions (SCD and HIV infection) were analyzed using nationally weighted data from the 1994 to 2003 Nationwide Inpatient Databases of the Healthcare Cost and Utilization Project. Demographic and hospital characteristics, length of stay, charges and the most frequent diagnoses and procedures performed during the hospitalization were compared. Multivariate logistic regression was used to analyze the effects of age, sex and HIV infection on number of hospitalizations for selected conditions.
There were an estimated 686 hospitalizations of children with SCD and HIV infection in the United States in the 10-year period 1994-2003; these hospitalizations aggregated in the South (78.2%) and their expected payer was mostly Medicaid/Medicare (82.0%). Their average length of stay was longer than that of children with SCD alone (8.0 days vs. 4.3 days, respectively), and the mean charges associated with the hospitalization were also higher ($18,291 vs. $9584). Compared with patients with SCD without HIV, HIV infection conferred a higher risk for hospitalizations for bacterial infections and sepsis (odds ratio 2.75; 95% CI, 1.66-4.6), but less of a risk for vaso-occlusive crises (odds ratio 0.32; 95% CI, 0.22-0.48). Inpatient case-fatality rate of children with SCD and HIV was no different from that of children with SCD alone, but lower than that of the rest of children with HIV infection.
Hospitalized children with SCD and HIV infection have higher odds of infection than those with SCD alone. Their inpatient case-fatality rate is lower than that of children with HIV infection alone. These findings should be considered in designing appropriate interventions for this population.
本研究旨在描述美国镰状细胞病（SCD）患儿和1型人类免疫缺陷病毒（HIV）感染患儿的住院使用模式。
利用医疗成本和利用项目1994年至2003年全国住院患者数据库中的全国加权数据，对患有这两种疾病（SCD和HIV感染）中的一种或两种的儿童的出院情况进行分析。比较了人口统计学和医院特征、住院时间、费用以及住院期间最常见的诊断和手术。采用多因素logistic回归分析年龄、性别和HIV感染对特定疾病住院次数的影响。
在1994 - 2003年的10年期间，美国估计有686例SCD和HIV感染患儿住院；这些住院病例集中在南部（78.2%），预期支付方大多是医疗补助/医疗保险（82.0%）。他们的平均住院时间比单纯患有SCD的儿童更长（分别为8.0天和4.3天），与住院相关的平均费用也更高（18,291美元对9584美元）。与未感染HIV的SCD患者相比，HIV感染使细菌感染和败血症住院风险更高（比值比2.75；95%置信区间，1.66 - 4.6），但血管闭塞性危机风险更低（比值比0.32；95%置信区间，0.22 - 0.48）。SCD和HIV感染患儿的住院病死率与单纯SCD患儿无异，但低于其他HIV感染患儿。
与单纯患有SCD的患儿相比，住院的SCD和HIV感染患儿感染几率更高。他们的住院病死率低于单纯HIV感染患儿。在为这一人群设计适当干预措施时应考虑这些发现。
