Zhu Xianming, Patel Eshan U, Berry Stephen A, Grabowski Mary K, Abraham Alison G, Althoff Keri N, Quinn Thomas C, Gebo Kelly A, Tobian Aaron A R
Department of Pathology, School of Medicine, The Johns Hopkins University, Baltimore, MD.
Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD.
J Acquir Immune Defic Syndr. 2025 Apr 1;98(4):334-339. doi: 10.1097/QAI.0000000000003577.
Although 30-day hospital readmission is a widely followed quality measure, there are limited US nationwide data to evaluate its trends among people with HIV (PWH) and the sex disparity over time. We describe the 30-day all-cause unplanned readmission trends among PWH and people without HIV (PWoH) in the United States.
Adult participants in the 2010-2020 Nationwide Readmissions Database, which weighted represents all US hospitalizations each year.
We defined index admission and unplanned readmission using the US Centers for Medicare & Medicaid Services criteria. Overall and sex-specific readmission risks were tabulated among the index admissions from adult PWH and PWoH each year in the 2010-2020 Nationwide Readmissions Database. Random effect linear and Poisson regressions were used to estimate risk difference and annual percentage change of the trend. We added a spline in 2015 and additionally stratified the analysis by age and patient's zip code median household income. All analyses were weighted to generate national estimates.
Approximately 140,000 index admissions from PWH and 25 million from PWoH were included each year. For PWoH between 2010 and 2020, annual readmission risk was stable at ∼12%. For PWH, readmission risk was stable at ∼22% during 2010-2015 and decreased from 22.0% in 2016 to 20.1% in 2020 (RD= -1.60 [95% CI: -2.24,-0.95]). Nonpregnant female PWH continued to have higher readmission risk than male PWH for all subgroups and all years. Nonpregnant female PWH <40 years had no reduction in readmission risk between 2016 and 2020 (RD= -0.45 [95% CI: -2.43, 1.53]).
There remains strong need for readmission reduction interventions focusing on PWH, especially for young female PWH.
尽管30天内再次入院是一项广泛采用的质量指标，但美国全国范围内用于评估艾滋病毒感染者（PWH）中该指标的趋势以及随时间变化的性别差异的数据有限。我们描述了美国PWH和非艾滋病毒感染者（PWoH）30天内全因非计划再次入院的趋势。
2010 - 2020年全国再入院数据库中的成年参与者，该数据库加权后代表每年美国所有住院情况。
我们使用美国医疗保险和医疗补助服务中心的标准定义首次入院和非计划再次入院。在2010 - 2020年全国再入院数据库中，每年对成年PWH和PWoH的首次入院情况进行总体和按性别分类的再入院风险列表统计。使用随机效应线性回归和泊松回归来估计风险差异和趋势的年度百分比变化。我们在2015年添加了样条，并按年龄和患者邮政编码中位数家庭收入对分析进行了额外分层。所有分析都进行了加权以生成全国估计值。
每年约有140,000例PWH的首次入院和2500万例PWoH的首次入院被纳入分析。2010年至2020年期间，PWoH的年度再入院风险稳定在约12%。对于PWH，2010 - 2015年期间再入院风险稳定在约22%，并从2016年的22.0%降至（RD = -1.60 [95% CI：-2.24，-0.95]）。2020年）。在所有亚组和所有年份中，非孕女性PWH的再入院风险继续高于男性PWH。2016年至2020年期间，年龄小于40岁的非孕女性PWH的再入院风险没有降低（RD = -0.45 [95% CI：-2.43，1.53]）。
仍然非常需要针对PWH的减少再入院干预措施，特别是针对年轻女性PWH。
