美国有和没有感染艾滋病毒的成年人的医院再入院情况：来自全国再入院数据库的调查结果。

Hospital readmissions among adults living with and without HIV in the US: findings from the Nationwide Readmissions Database.

作者信息

Zhu Xianming, Patel Eshan U, Berry Stephen A, Grabowski Mary K, Abraham Alison G, Davy-Mendez Thibaut, Hogan Brenna, Althoff Keri N, Redd Andrew D, Laeyendecker Oliver, Quinn Thomas C, Gebo Kelly A, Tobian Aaron A R

机构信息

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.

出版信息

EClinicalMedicine. 2024 Jun 20;73:102690. doi: 10.1016/j.eclinm.2024.102690. eCollection 2024 Jul.

DOI:10.1016/j.eclinm.2024.102690

PMID:39007069

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11246008/

Abstract

BACKGROUND

Thirty-day hospital readmission measures quality of care, but there are limited data among people with HIV (PWH) and people without HIV (PWoH) in the era of universal recommendation for antiretroviral therapy. We descriptively compared 30-day all-cause, unplanned readmission risk between PWH and PWoH.

METHODS

A retrospective cohort study was conducted using the 2019 Nationwide Readmissions Database (2019/01/01-2019/12/31), an all-payer database that represents all US hospitalizations. Index (initial) admissions and readmissions were determined using US Centers for Medicare & Medicaid Services definitions. Crude and age-adjusted risk ratios (aRR) comparing the 30-day all-cause, unplanned readmission risk between PWH to PWoH were estimated using random effect logistic regressions and predicted marginal estimates. Survey weights were applied to all analyses.

FINDINGS

We included 24,338,782 index admissions from 18,240,176 individuals. The median age was 52(IQR = 40-60) years for PWH and 61(IQR = 38-74) years for PWoH. The readmission risk was 20.9% for PWH and 12.2% for PWoH (age-adjusted-RR:1.88 [95%CI = 1.84-1.92]). Stratified by age and sex, young female (age 18-29 and 30-39 years) PWH had a higher readmission risk than young female PWoH (aRR = 3.50 [95%CI = 3.11-3.88] and aRR = 4.00 [95%CI = 3.67-4.32], respectively). While the readmission risk increased with age among PWoH, the readmission risk was persistently high across all age groups among PWH. The readmission risk exceeded 30% for PWH admitted for hypertensive heart disease, heart failure, and chronic kidney disease.

INTERPRETATION

PWH have a disproportionately higher risk of readmission than PWoH, which is concerning given the aging profile of PWH. More efforts are needed to address readmissions among PWH.

FUNDING

US National Institutes of Health.

摘要

背景

30天内再次入院率可衡量医疗质量，但在普遍推荐抗逆转录病毒治疗的时代，有关艾滋病毒感染者（PWH）和非艾滋病毒感染者（PWoH）的数据有限。我们对PWH和PWoH之间30天全因非计划再次入院风险进行了描述性比较。

方法

使用2019年全国再入院数据库（2019年1月1日至2019年12月31日）进行了一项回顾性队列研究，该数据库是一个代表美国所有住院情况的全付费者数据库。首次（初始）入院和再次入院情况根据美国医疗保险和医疗补助服务中心的定义确定。使用随机效应逻辑回归和预测边际估计来估计比较PWH和PWoH之间30天全因非计划再次入院风险的粗风险比和年龄调整风险比（aRR）。所有分析均应用调查权重。

结果

我们纳入了来自18240176名个体的24338782例首次入院病例。PWH的年龄中位数为52岁（IQR = 40 - 60），PWoH为61岁（IQR = 38 - 74）。PWH的再次入院风险为20.9%，PWoH为12.2%（年龄调整RR：1.88 [95%CI = 1.84 - 1.92]）。按年龄和性别分层，年轻女性（18 - 29岁和30 - 39岁）PWH的再次入院风险高于年轻女性PWoH（aRR分别为3.50 [95%CI = 3.11 - 3.88]和4.00 [95%CI = 3.67 - 4.32]）。虽然PWoH的再次入院风险随年龄增加，但PWH所有年龄组的再次入院风险一直很高。因高血压性心脏病、心力衰竭和慢性肾病入院的PWH再次入院风险超过30%。