Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA.
Public Health Rep. 2011 Sep-Oct;126 Suppl 3(Suppl 3):89-101. doi: 10.1177/00333549111260S314.
People with severe mental illness (SMI) may be at increased risk for several adverse health conditions, including HIV/AIDS. This disproportionate disease burden has been studied primarily at the individual rather than community level, in part due to the rarity of data sources linking individual information on medical and mental health characteristics with community-level data. We demonstrated the potential of Medicaid data to address this gap.
We analyzed data on Medicaid beneficiaries with schizophrenia from eight states that account for 66% of cumulative AIDS cases nationally.
Across 44 metropolitan statistical areas (MSAs), the treated prevalence of HIV among adult Medicaid beneficiaries diagnosed with schizophrenia was 1.56% (standard deviation = 1.31%). To explore possible causes of variation, we linked claims files with a range of MSA social and contextual variables including local AIDS prevalence rates, area-based economic measures, crime rates, substance abuse treatment resources, and estimates of injection drug users (IDUs) and HIV infection among IDUs, which strongly predicted community infection rates among people with schizophrenia.
Effective strategies for HIV prevention among people with SMI may include targeting prevention efforts to areas where risk is greatest; examining social network links between IDU and SMI groups; and implementing harm reduction, drug treatment, and other interventions to reduce HIV spread among IDUs. Our findings also suggest the need for research on HIV among people with SMI that examines geographical variation and demonstrates the potential use of health-care claims data to provide epidemiologic insights into small-area variations and trends in physical health among those with SMI.
患有严重精神疾病（SMI）的人可能面临多种健康不良状况的风险，包括艾滋病毒/艾滋病。这种不成比例的疾病负担主要在个体层面而非社区层面进行了研究，部分原因是缺乏将个人医疗和心理健康特征信息与社区层面数据相联系的数据源。我们展示了医疗补助数据在解决这一差距方面的潜力。
我们分析了来自八个州的接受医疗补助的精神分裂症患者的数据，这些州占全国累积艾滋病病例的 66%。
在 44 个大都市统计区（MSA）中，诊断为精神分裂症的成年医疗补助受助人中艾滋病毒的治疗患病率为 1.56%（标准差=1.31%）。为了探索变异的可能原因，我们将索赔文件与一系列 MSA 社会和环境变量相联系，包括当地艾滋病流行率、基于区域的经济措施、犯罪率、药物滥用治疗资源以及注射吸毒者（IDU）的估计数和 IDU 中的 HIV 感染情况，这些因素强烈预测了精神分裂症患者的社区感染率。
针对 SMI 人群的 HIV 预防的有效策略可能包括将预防工作针对风险最大的地区；检查 IDU 和 SMI 群体之间的社交网络联系；以及实施减少伤害、药物治疗和其他干预措施，以减少 IDU 中 HIV 的传播。我们的研究结果还表明，需要对 SMI 人群中的 HIV 进行研究，以检验地理变异并展示使用医疗保健索赔数据为了解 SMI 人群中身体健康的小区域变异和趋势提供流行病学见解的潜力。
