Utilization of Healthcare Resources by HIV-Positive Children in the United States: A National Perspective.

OBJECTIVE

We characterized and estimated the cost of inpatient hospital utilization by US pediatric patients who tested positive for the human immunodeficiency virus (HIV).

METHODS

The 2012 Kids' Inpatient Database was analyzed to provide a descriptive assessment of national inpatient hospital utilization. We analyzed a stratified probability sampling of 3.2 million pediatric hospital discharges weighted to 6.7 million national discharges. Descriptive statistics for hospital and patient characteristics were identified and binary variables were analyzed using the Student test. The Kids' Inpatient Database is the largest available all-payer pediatric (20 years old and younger) inpatient care database in the United States, yielding national estimates of hospital inpatient stays. Children aged 17 years and younger were included in the study and conditions related to pregnancy and delivery.

RESULTS

We estimated that 1344 pediatric discharges were associated with an HIV diagnosis, totaling 10,704 inpatient days at a cost of $91 million. Among pediatric patients with HIV, 55% were African American, 20% were white, 15% were Asian/Pacific Islander, 8% were other races (including Hispanics and Native Americans), and 51% were female. Children who were HIV positive were more likely to have longer mean hospital stays, have higher mean hospital charges, be of a higher median age (8 years and older), have Medicaid insurance, come from lower-income families, be treated in urban teaching hospitals, and be more likely to die during hospitalization ( < 0.01 for all). Among non-HIV-related pediatric discharges, 20% occurred in households with a mean annual income >$63,000 compared with only 12% for children who were HIV positive. During hospitalization, at least one procedure was performed in 56.6% of children with HIV compared with 45.65% of hospitalized children without HIV. The most frequently observed diagnoses associated with children infected with HIV were gastrointestinal disorders, mental disorders, and bacterial infections and sepsis.

CONCLUSIONS

The results suggest that pediatric patients who were HIV positive were significantly older, from lower-income areas, and members of minority groups. They underwent more procedures during hospitalization, incurred more than twice the total cost, stayed in the hospital twice as long, and had statistically higher in-hospital mortality than children who were HIV negative. As we continue to explore effective and judicious treatment options for patients who are HIV positive, our national estimates of resource utilization can be used to conduct a more detailed examination of current medical practices and specific patterns of diagnoses associated with HIV infection in the US pediatric population.