Zucconi S L, Jacobson L P, Schrager L K, Kass N E, Lave J R, Carson C A, Morgenstern H, Arno P S, Graham N M
Health Policy Institute, Graduate School of Public Health, University of Pittsburgh, PA 15261.
J Acquir Immune Defic Syndr (1988). 1994 Jun;7(6):607-16.
The effects of human immunodeficiency virus type 1 (HIV-1) serostatus, AIDS, and level of immunosuppression on health service use were examined in the Multicenter AIDS Cohort Study. Data on self-reported hospitalizations, outpatient medical services (non-emergency room) and emergency room care during the preceding 6 months were collected for 3,447 homosexual/bisexual men returning for their 14th and/or 15th semiannual visits in Chicago, Baltimore, Los Angeles, and Pittsburgh. AIDS-free seropositive men with CD4+ cells < 200/microliters were more likely to be hospitalized [odds ratio (OR) = 2.3, 95% confidence limits (CL) = 1.4, 3.8] and use outpatient medical care (OR = 7.9, 95% CL = 4.9, 12.6), compared with seronegative men. Increased outpatient care was initiated at the earliest stages of HIV-1 infection, even when CD4+ cells were > 500/microliter. Dramatic increases in outpatient care for each level of immunosuppression were observed. HIV-1-related symptoms were associated with increased hospitalizations (OR = 4.8, 95% CL = 3.2, 7.3), use of outpatient medical services (OR = 3.3, 95% CL = 1.9, 5.6), and emergency room care (OR = 3.1, 95% CL = 2.1, 4.6). Persons with AIDS and < or = 50 CD4+ cells/microliter most likely to be hospitalized (OR = 8.1; 95% CL = 4.4, 14.9). No significant difference (p > 0.05) in emergency room use was observed according to HIV-1 serostatus, AIDS, or immunosuppression, after adjusting for insurance and clinical symptoms. To the extent that CD4+ cell counts are used as one of the criteria for an AIDS diagnosis and such a diagnosis broadens available benefits to persons with HIV disease, the pattern of health care services described here will be important for health care providers and planners.
在多中心艾滋病队列研究中，研究了1型人类免疫缺陷病毒（HIV-1）血清状态、艾滋病以及免疫抑制水平对医疗服务利用情况的影响。收集了芝加哥、巴尔的摩、洛杉矶和匹兹堡3447名男同性恋/双性恋男性在第14次和/或第15次半年随访期间自我报告的前6个月住院情况、门诊医疗服务（非急诊室）和急诊室护理数据。与血清阴性男性相比，CD4+细胞<200/微升的无艾滋病血清阳性男性更有可能住院[比值比（OR）=2.3，95%置信区间（CL）=1.4，3.8]并使用门诊医疗服务（OR = 7.9，95% CL = 4.9，12.6）。即使CD4+细胞>500/微升，在HIV-1感染的最早阶段门诊护理就开始增加。观察到每个免疫抑制水平的门诊护理都有显著增加。与HIV-1相关的症状与住院增加（OR = 4.8，95% CL = 3.2，7.3）、门诊医疗服务使用（OR = 3.3，95% CL = 1.9，5.6）和急诊室护理（OR = 3.1，95% CL = 2.1，4.6）相关。患有艾滋病且CD4+细胞≤50/微升的人最有可能住院（OR = 8.1；95% CL = 4.4，14.9）。在调整保险和临床症状后，根据HIV-1血清状态、艾滋病或免疫抑制情况，急诊室使用情况未观察到显著差异（p>0.05）。就CD4+细胞计数被用作艾滋病诊断标准之一且这种诊断扩大了HIV疾病患者可获得的福利而言，此处描述的医疗服务模式对医疗服务提供者和规划者将具有重要意义。
