1 Illinois Department of Public Health and Office of Preparedness and Response, Centers for Disease Control and Prevention, Chicago, IL, USA.
Public Health Rep. 2018 Jul/Aug;133(4):442-451. doi: 10.1177/0033354918777254. Epub 2018 Jun 18.
To understand trends in health care use among people living with HIV/AIDS (PLWHA), this study compared trends in hospitalization rates, comorbidities, and hospital death rates of hospitalized PLWHA with the overall hospitalized population in Illinois during 2008-2014.
This study identified principal hospitalizations (the principal discharge diagnosis coded with an HIV-related billing code) and secondary HIV hospitalizations (a non-principal discharge diagnosis coded with an HIV-related billing code) from 2008-2014 Illinois hospital discharge data. Hospitalization rates among PLWHA were calculated using prevalence data from the Illinois Electronic HIV/AIDS Registry; US Census population estimates were used to calculate overall Illinois hospitalization rates. Joinpoint regression analysis was used to assess trends overall and among demographic subgroups. Comorbidities and discharge status for all hospitalizations were identified.
In 2014, the hospitalization rate was 2.2 times higher among PLWHA than among the overall Illinois hospitalized population. From 2008 to 2014, principal HIV hospitalization rates per 1000 PLWHA decreased by 48% (from 71 to 37) and secondary HIV hospitalization rates declined by 26% (from 296 to 218). The decline in the principal HIV hospitalization rate was steepest from 2008 to 2011 (annual percentage change = -16.0%; P = .003). Mood disorders, substance-related diagnoses, and schizophrenia accounted for 18% to 22% of principal hospitalizations among PLWHA compared with 7% to 8% of overall Illinois hospitalizations. Hepatitis as a comorbidity was more common among hospitalized PLWHA (18%-22%) than among the overall Illinois hospitalized population (1.4%-1.5%). Hospitalized PLWHA were 3 times more likely than the overall Illinois hospitalized population to die while hospitalized.
HIV hospitalizations are largely preventable with appropriate treatment and adherence. Additional efforts to improve retention in HIV care that address comorbidities of PLWHA are needed.
为了了解艾滋病毒/艾滋病（PLWHA）患者的医疗保健使用趋势，本研究比较了 2008 年至 2014 年期间伊利诺伊州住院 PLWHA 的住院率、合并症和住院死亡率与全州住院患者的趋势。
本研究从 2008 年至 2014 年伊利诺伊州医院出院数据中确定了主要住院治疗（主要出院诊断编码有 HIV 相关计费代码）和次要 HIV 住院治疗（非主要出院诊断编码有 HIV 相关计费代码）。使用来自伊利诺伊州电子艾滋病毒/艾滋病登记处的患病率数据计算 PLWHA 的住院率；使用美国人口普查人口估计数计算伊利诺伊州的总体住院率。使用 Joinpoint 回归分析评估总体趋势和人口统计学亚组趋势。确定所有住院患者的合并症和出院情况。
2014 年，PLWHA 的住院率是全州住院患者的 2.2 倍。从 2008 年到 2014 年，每 1000 名 PLWHA 的主要 HIV 住院率下降了 48%（从 71 降至 37），次要 HIV 住院率下降了 26%（从 296 降至 218）。从 2008 年到 2011 年，主要 HIV 住院率的下降幅度最大（年变化百分比 = -16.0%；P =.003）。与全州住院患者的 7%至 8%相比，心境障碍、物质相关诊断和精神分裂症占 PLWHA 主要住院的 18%至 22%。住院 PLWHA 的合并症肝炎更为常见（18%至 22%），而全州住院患者的合并症肝炎为 1.4%至 1.5%。住院 PLWHA 的住院死亡率是全州住院患者的 3 倍。
通过适当的治疗和治疗依从性，HIV 住院治疗在很大程度上是可以预防的。需要进一步努力改善 PLWHA 的艾滋病毒护理保留率，以解决其合并症问题。
