School of Medicine.
Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
J Infect Dis. 2023 Dec 20;228(12):1699-1708. doi: 10.1093/infdis/jiad396.
Hospital readmission trends for persons with human immunodeficiency virus (PWH) in North America in the context of policy changes, improved antiretroviral therapy (ART), and aging are not well-known. We examined readmissions during 2005-2018 among adult PWH in NA-ACCORD.
Linear risk regression estimated calendar trends in 30-day readmissions, adjusted for demographics, CD4 count, AIDS history, virologic suppression (<400 copies/mL), and cohort.
We examined 20 189 hospitalizations among 8823 PWH (73% cisgender men, 38% White, 38% Black). PWH hospitalized in 2018 versus 2005 had higher median age (54 vs 44 years), CD4 count (469 vs 274 cells/μL), and virologic suppression (83% vs 49%). Unadjusted 30-day readmissions decreased from 20.1% (95% confidence interval [CI], 17.9%-22.3%) in 2005 to 16.3% (95% CI, 14.1%-18.5%) in 2018. Absolute annual trends were -0.34% (95% CI, -.48% to -.19%) in unadjusted and -0.19% (95% CI, -.35% to -.02%) in adjusted analyses. By index hospitalization reason, there were significant adjusted decreases only for cardiovascular and psychiatric hospitalizations. Readmission reason was most frequently in the same diagnostic category as the index hospitalization.
Readmissions decreased over 2005-2018 but remained higher than the general population's. Significant decreases after adjusting for CD4 count and virologic suppression suggest that factors alongside improved ART contributed to lower readmissions. Efforts are needed to further prevent readmissions in PWH.
在政策变化、改善抗逆转录病毒疗法（ART）和人口老龄化的背景下，北美的艾滋病毒感染者（PWH）住院人数的趋势尚不清楚。我们在 NA-ACCORD 中检查了 2005 年至 2018 年期间成年 PWH 的住院再入院情况。
线性风险回归估计了 30 天内再入院的日历趋势，调整了人口统计学、CD4 计数、艾滋病史、病毒学抑制（<400 拷贝/毫升）和队列。
我们检查了 8823 名 PWH（73%顺性别男性，38%白种人，38%黑人）中的 20189 例住院。与 2005 年相比，2018 年住院的 PWH 的中位年龄（54 岁比 44 岁）、CD4 计数（469 比 274 个细胞/μL）和病毒学抑制率（83%比 49%）更高。未调整的 30 天再入院率从 2005 年的 20.1%（95%置信区间[CI]，17.9%-22.3%）下降到 2018 年的 16.3%（95% CI，14.1%-18.5%）。未调整的绝对年度趋势为-0.34%（95% CI，-0.48%至-0.19%），调整后的分析为-0.19%（95% CI，-0.35%至-0.02%）。按索引住院原因，仅心血管和精神科住院的调整后下降具有统计学意义。再入院的原因与索引住院的诊断类别最常相同。
2005 年至 2018 年期间，再入院人数下降，但仍高于一般人群。在调整 CD4 计数和病毒学抑制后，再入院率显著下降，这表明除了改善 ART 外，还有其他因素导致再入院率下降。需要努力进一步预防 PWH 的再入院。
