Drallmeier Theresa, Garrett Elizabeth Keegan, Meyr Ashley, Salas Joanne, Scherrer Jeffrey F
Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA.
Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA.
Prev Med. 2022 Nov;164:107344. doi: 10.1016/j.ypmed.2022.107344. Epub 2022 Nov 9.
Due to a large number of small studies and limited control for confounding, existing evidence regarding patient characteristics associated with PrEP initiation is inconsistent. We used a large electronic health record cohort to determine which demographic, physical morbidity and psychiatric conditions are associated with PrEP initiation. Eligible adult (≥18 years) patients were selected from the Optum® de-identified Electronic Health Record dataset (2010-2018). Non-HIV sexually transmitted diseases and high risk sexual behavior was used to identify patients eligible for PrEP. A fully adjusted Poisson regression model estimated the association between age, gender, race, insurance status, comorbidity index, depression, anxiety, dysthymia, severe mental illness, substance use disorder and nicotine dependence/smoking and rate of PrEP initiation. The cohort (n = 30,909) was mostly under 40 years of age (64.3%), 67.6% were female and 58.2% were White. The cumulative incidence of PrEP initiation was 1.3% (n = 408). Patients ≥60 years of age, compared to 18-29 year olds and Black compared to White patients had significantly lower rates of PrEP initiation. Anxiety disorder was significantly associated with higher rate of PrEP initiation (RR = 1.67; 95%CI:1.20-2.33) and nicotine dependence/smoking with a lower rate (RR = 0.73; 95%CI:0.54-0.97). PrEP is underutilized, and a race disparity exists in PrEP initiation. In the context of existing research, nicotine dependence/smoking is the patient characteristic most consistently associated lower rates of starting PrEP. Given the high prevalence of smoking in PrEP eligible patients, physicians may want to integrate discussions of smoking cessation in patient-provider decisions to start PrEP.
由于存在大量小型研究且对混杂因素的控制有限，关于与开始使用暴露前预防（PrEP）相关的患者特征的现有证据并不一致。我们使用了一个大型电子健康记录队列来确定哪些人口统计学、身体疾病和精神疾病状况与开始使用PrEP有关。符合条件的成年（≥18岁）患者从Optum®去识别化电子健康记录数据集（2010 - 2018年）中选取。非艾滋病毒性传播疾病和高危性行为被用于识别符合PrEP条件的患者。一个完全调整的泊松回归模型估计了年龄、性别、种族、保险状况、合并症指数、抑郁症、焦虑症、心境恶劣、严重精神疾病、物质使用障碍以及尼古丁依赖/吸烟与开始使用PrEP的比率之间的关联。该队列（n = 30,909）大多年龄在40岁以下（64.3%），67.6%为女性，58.2%为白人。开始使用PrEP的累积发病率为1.3%（n = 408）。与18 - 29岁的患者相比，60岁及以上的患者以及与白人患者相比黑人患者开始使用PrEP的比率显著更低。焦虑症与开始使用PrEP的比率较高显著相关（风险比RR = 1.67；95%置信区间CI：1.20 - 2.33），而尼古丁依赖/吸烟与较低的比率相关（RR = 0.73；95%CI：0.54 - 0.97）。PrEP未得到充分利用，并且在开始使用PrEP方面存在种族差异。在现有研究背景下，尼古丁依赖/吸烟是与开始PrEP的比率较低最始终相关的患者特征。鉴于符合PrEP条件的患者中吸烟率很高，医生可能希望在医患关于开始使用PrEP的决策讨论中纳入戒烟内容。
