走出数据库阴影:在一大群艾滋病毒感染者中描述无证移民的特征。

Emerging from the database shadows: characterizing undocumented immigrants in a large cohort of HIV-infected persons.

作者信息

Ross Jonathan, Hanna David B, Felsen Uriel R, Cunningham Chinazo O, Patel Viraj V

机构信息

a Division of General Internal Medicine, Department of Medicine , Montefiore Medical Center , Bronx , USA.

b Department of Epidemiology and Population Health , Albert Einstein College of Medicine , Bronx , USA.

出版信息

AIDS Care. 2017 Dec;29(12):1491-1498. doi: 10.1080/09540121.2017.1307921. Epub 2017 Mar 27.

Abstract

Little is known about how HIV affects undocumented immigrants despite social and structural factors that may place them at risk of poor HIV outcomes. Our understanding of the clinical epidemiology of HIV-infected undocumented immigrants is limited by the challenges of determining undocumented immigration status in large data sets. We developed an algorithm to predict undocumented status using social security number (SSN) and insurance data. We retrospectively applied this algorithm to a cohort of HIV-infected adults receiving care at a large urban healthcare system who attended at least one HIV-related outpatient visit from 1997 to 2013, classifying patients as "screened undocumented" or "documented". We then reviewed the medical records of screened undocumented patients, classifying those whose records contained evidence of undocumented status as "undocumented per medical chart" (charted undocumented). Bivariate measures of association were used to identify demographic and clinical characteristics associated with undocumented immigrant status. Of 7593 patients, 205 (2.7%) were classified as undocumented by the algorithm. Compared to documented patients, undocumented patients were younger at entry to care (mean 38.5 years vs. 40.6 years, p < 0.05), less likely to be female (33.2% vs. 43.1%, p < 0.01), less likely to report injection drug use as their primary HIV risk factor (3.4% vs. 18.0%, p < 0.001), and had lower median CD4 count at entry to care (288 vs. 339 cells/mm, p < 0.01). After medical record review, we re-classified 104 patients (50.7%) as charted undocumented. Demographic and clinical characteristics of charted undocumented did not differ substantially from screened undocumented. Our algorithm allowed us to identify and clinically characterize undocumented immigrants within an HIV-infected population, though it overestimated the prevalence of patients who were undocumented.

摘要

尽管存在一些社会和结构因素可能使无证移民面临艾滋病病毒感染不良后果的风险,但关于艾滋病病毒如何影响无证移民的情况却鲜为人知。我们对感染艾滋病病毒的无证移民临床流行病学的了解受到在大型数据集中确定无证移民身份挑战的限制。我们开发了一种算法,利用社会安全号码(SSN)和保险数据来预测无证身份。我们回顾性地将该算法应用于1997年至2013年期间在一个大型城市医疗系统接受护理且至少参加过一次与艾滋病病毒相关门诊就诊的感染艾滋病病毒的成年人群体,将患者分类为“筛查为无证”或“有证件”。然后我们查阅了筛查为无证患者的病历,将那些病历中有无证身份证据的患者分类为“根据病历记录为无证”(病历记录为无证)。采用双变量关联测量来确定与无证移民身份相关的人口统计学和临床特征。在7593名患者中,有205名(2.7%)被该算法分类为无证。与有证件的患者相比,无证患者开始接受护理时更年轻(平均38.5岁对40.6岁,p<0.05),女性比例更低(33.2%对43.1%,p<0.01),报告注射吸毒为其主要艾滋病病毒风险因素的可能性更低(3.4%对18.0%,p<0.001),且开始接受护理时的CD4细胞计数中位数更低(288对339个细胞/mm³,p<0.01)。经过病历审查后,我们将104名患者(50.7%)重新分类为病历记录为无证。病历记录为无证的患者的人口统计学和临床特征与筛查为无证的患者没有实质性差异。我们的算法使我们能够在感染艾滋病病毒的人群中识别无证移民并对其进行临床特征描述,尽管它高估了无证患者的患病率。

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