Department of Medicine, Center for AIDS Prevention Studies, University of California - San Francisco, 550 16th Street 3rd Floor, San Francisco, CA, USA.
Division of HIV, ID and Global Medicine, Department of Medicine, University of California - San Francisco, San Francisco, CA, USA.
J Behav Med. 2019 Jun;42(3):561-566. doi: 10.1007/s10865-018-9986-8. Epub 2018 Oct 30.
The disparity in viral suppression rates between Latino and non-Latino White patients in HIV care appears to be narrowing, but it is unclear if depression and substance use perpetuate this disparity. We analyzed electronic medical records from the CFAR network of integrated clinical systems cohort. First observations/enrollment data collected between 2007 and 2013 were analyzed, which included survey (race/ethnicity, depression, substance use, adherence) and clinical data (viral suppression). We estimated indirect effects with a regression-based bootstrapping method. In 3129 observations, Latinos and non-Latino Whites did not differ in depression or alcohol use (ORs 1.11, 0.99, ns), but did in drug use (OR 1.13, p < .001). For all patients, depression and substance use were indirectly associated with small increases (ORs 1.02-1.66) in the odds for a detectable viral load, via worse adherence. We conclude that variables not captured in EMR systems (e.g., health literacy, structural factors) may better explain viral suppression disparities that persist.
HIV 护理中拉丁裔和非拉丁裔白种人之间病毒抑制率的差异似乎正在缩小，但尚不清楚抑郁和药物使用是否会使这种差异持续存在。我们分析了综合临床系统队列 CFAR 网络的电子病历。分析了 2007 年至 2013 年间收集的首次观察/入组数据，其中包括调查（种族/民族、抑郁、药物使用、依从性）和临床数据（病毒抑制）。我们使用基于回归的自举法估计间接效应。在 3129 次观察中，拉丁裔和非拉丁裔白人在抑郁或饮酒方面没有差异（OR 1.11，0.99，ns），但在药物使用方面有差异（OR 1.13，p<.001）。对于所有患者，抑郁和药物使用通过较差的依从性与检测到的病毒载量的几率略有增加（ORs 1.02-1.66）间接相关。我们得出结论，电子病历系统中未捕获的变量（例如，健康素养、结构因素）可能更好地解释持续存在的病毒抑制差异。
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