The association between life chaos, health care use, and health status among HIV-infected persons.

BACKGROUND

Whether having a stable and predictable lifestyle is associated with health care use and health status among HIV patients is unknown.

OBJECTIVE

To develop and test the reliability and validity of a measure of life chaos for adults with HIV and examine its association with health care use and health status.

DESIGN

Prospective cohort study.

PARTICIPANTS

Two hundred twenty HIV-infected persons recruited from those who tested positive in a mobile testing van and from HIV clinics serving low-income populations.

MEASUREMENTS

Participants completed a survey every 6 months, assessing their health care use, SF-12 mental and physical health status and life chaos.

RESULTS

Cronbach's alpha for the six-item measure of chaos was .67. Those without a spouse or partner and those with one or more unmet social service needs, such as housing or transportation, had higher chaos scores. Compared to those with less chaos, those with more chaos were less likely to have two or more outpatient visits (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI]: 0.24-0.98), more likely to have two or more missed visits (adjusted OR 2.30, 95%CI: 1.20-4.41) in the 6 months before study enrollment and had lower mental health status at enrollment and at follow-up. Life chaos was not associated with emergency department visits or physical health status.

CONCLUSIONS

We created a new measure of life chaos, which was associated with outpatient visits and mental health status. Chaos may be an important barrier to regular medical care. Future studies need to test this measure in more diverse populations and those with other diseases.