Alemu Brook T, Brock David W, Abate Sara N, Martin Brian C
From the Integrated Health Sciences Program, School of Health Sciences, Western Carolina University, Cullowhee, North Carolina, the College of Sciences, Old Dominion University, Norfolk, Virginia, and the Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk.
South Med J. 2020 Feb;113(2):74-80. doi: 10.14423/SMJ.0000000000001065.
We characterized and estimated the cost of inpatient hospital utilization by US pediatric patients who tested positive for the human immunodeficiency virus (HIV).
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.
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.
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.
我们对美国感染人类免疫缺陷病毒（HIV）呈阳性的儿科患者的住院利用情况进行了特征描述并估算了成本。
对2012年儿童住院数据库进行分析，以对全国住院利用情况进行描述性评估。我们分析了320万例儿科医院出院病例的分层概率抽样，加权后代表670万例全国出院病例。确定了医院和患者特征的描述性统计数据，并使用学生t检验分析二元变量。儿童住院数据库是美国现有的最大的全付费儿科（20岁及以下）住院护理数据库，可得出全国住院天数的估计值。17岁及以下儿童以及与妊娠和分娩相关的病症被纳入研究。
我们估计有1344例儿科出院病例与HIV诊断相关，总计10704个住院日，费用为9100万美元。在感染HIV的儿科患者中，55%为非裔美国人，20%为白人，15%为亚裔/太平洋岛民，8%为其他种族（包括西班牙裔和美洲原住民），51%为女性。HIV呈阳性的儿童更有可能平均住院时间更长、平均住院费用更高、年龄中位数更高（8岁及以上）、拥有医疗补助保险、来自低收入家庭、在城市教学医院接受治疗，并且在住院期间死亡的可能性更高（所有情况P<0.01）。在与HIV无关的儿科出院病例中，20%发生在平均年收入超过63000美元的家庭，而HIV呈阳性的儿童这一比例仅为12%。在住院期间，56.6%感染HIV的儿童至少接受了一项手术，而未感染HIV的住院儿童这一比例为45.65%。与感染HIV的儿童最常观察到的诊断相关的是胃肠道疾病、精神障碍以及细菌感染和败血症。
结果表明，HIV呈阳性的儿科患者年龄明显更大，来自低收入地区，且属于少数群体。他们在住院期间接受的手术更多，总费用是未感染HIV儿童的两倍多，住院时间是未感染HIV儿童的两倍，并且住院死亡率在统计学上更高。随着我们继续探索针对HIV呈阳性患者的有效且明智的治疗方案，我们对资源利用的全国估计可用于更详细地检查当前的医疗实践以及美国儿科人群中与HIV感染相关的特定诊断模式。
