Cole Megan B, Galárraga Omar, Rahman Momotazur, Wilson Ira B
Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts.
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
Open Forum Infect Dis. 2019 Mar 10;6(4):ofz124. doi: 10.1093/ofid/ofz124. eCollection 2019 Apr.
As antiretroviral therapy has become more effective, persons with HIV live longer and develop conditions that are characteristic of older populations. Understanding changes in comorbid conditions has important implications for the complexity and cost of care, particularly for Medicaid programs and their enrollees, which comprise about 40% of all persons with HIV. Thus, our objective was to examine trends in comorbid conditions for Medicaid enrollees with HIV.
Using 2001-2012 administrative claims data from the 14 states (NY, CA, FL, TX, MD, NJ, PA, IL, GA, NC, VA, LA, OH, MA) with the highest HIV prevalence, we identified 494 322 unique Medicaid enrollees with HIV, representing 5.8 million person-quarters after exclusions. We estimated changes over time in enrollee characteristics, proportions of enrollees with the 10 most common comorbid conditions, and number of comorbid conditions per enrollee.
Over time, the average age for HIV Medicaid enrollees increased, and the proportion enrolled in a managed care plan also increased. In 2012, the highest proportion of enrollees exhibited evidence of hypertension (31%), psychiatric disease (26%), any liver disease (25%), and pulmonary disorder (23%). Nine of the 10 comorbid conditions increased over time, whereas HIV-related conditions declined. The largest adjusted relative increases in 2012 vs 2003 were observed for renal insufficiency (adjusted odds ratio [aOR], 2.20; < .001), hyperlipidemia (aOR, 1.80; < .001), and psychiatric disease (aOR, 1.45; < .001).
Despite improvements in antiretroviral therapy and better control of patients' HIV, we found substantial increases in rates of comorbid conditions over time. These findings have important implications for the complexity and costs of clinical care and for state Medicaid programs.
随着抗逆转录病毒疗法变得更加有效，感染艾滋病毒的人寿命延长，并出现了老年人群特有的病症。了解合并症的变化对护理的复杂性和成本具有重要意义，特别是对于医疗补助计划及其参保者而言，他们约占所有艾滋病毒感染者的40%。因此，我们的目标是研究医疗补助计划中艾滋病毒参保者合并症的趋势。
利用2001 - 2012年来自艾滋病毒感染率最高的14个州（纽约州、加利福尼亚州、佛罗里达州、得克萨斯州、马里兰州、新泽西州、宾夕法尼亚州、伊利诺伊州、佐治亚州、北卡罗来纳州、弗吉尼亚州、路易斯安那州、俄亥俄州、马萨诸塞州）的行政索赔数据，我们识别出494322名独特的艾滋病毒医疗补助参保者，排除后代表580万人季度。我们估计了参保者特征、患有10种最常见合并症的参保者比例以及每名参保者合并症数量随时间的变化。
随着时间的推移，艾滋病毒医疗补助参保者的平均年龄增加，参加管理式护理计划的比例也增加。2012年，参保者中高血压（31%）、精神疾病（26%）、任何肝脏疾病（25%）和肺部疾病（23%）的比例最高。10种合并症中有9种随时间增加，而与艾滋病毒相关的病症则下降。2012年与2003年相比，调整后相对增幅最大的是肾功能不全（调整优势比[aOR]，2.20；P <.001）、高脂血症（aOR，1.80；P <.001）和精神疾病（aOR，1.45；P <.001）。
尽管抗逆转录病毒疗法有所改进且患者的艾滋病毒得到了更好的控制，但我们发现合并症的发生率随着时间的推移大幅增加。这些发现对临床护理的复杂性和成本以及州医疗补助计划具有重要意义。
