Rosenblum L S, Castro K G, Dooley S, Morgan M
Centers for Disease Control and Prevention, Atlanta, Georgia.
Ann Intern Med. 1994 Nov 15;121(10):786-92. doi: 10.7326/0003-4819-121-10-199411150-00009.
To evaluate the effect of human immunodeficiency virus (HIV) infection and tuberculosis on hospitalizations and the cost of care.
National Hospital Discharge Survey, a nationally representative survey of discharges from U.S. nonfederal short-stay hospitals, and statewide billing information.
Patients 15 to 44 years of age with a listed diagnosis of HIV infection (n = 418,200) or active tuberculosis (n = 77,700) during 1985-1990.
During 1985-1990, hospitalizations related to HIV infection increased sixfold, from 18 to 102 per 100,000 persons; during 1988-1990, hospitalizations related to tuberculosis increased twofold, from 8 to 16 per 100,000 persons. The prevalence of tuberculosis among HIV-infected patients increased from 2.4% in 1985-1988 to 5.1% in 1989-1990 (P = 0.003). The prevalence of HIV infection among patients with tuberculosis increased from 11% in 1985-1988 to 28% in 1989 to 39% in 1990 (P < 0.001). Infection with HIV was more prevalent among patients with extrapulmonary tuberculosis (31%) than among those with pulmonary tuberculosis (18%) (P = 0.01). An increase in the duration of hospital stay was associated with both tuberculosis and HIV infection. From 1985 to 1990, inpatient care costs increased 7.7-fold and 3.2-fold for HIV and tuberculosis hospitalizations, respectively. During this period, HIV and tuberculosis hospitalizations resulted in 5,793,000 and 1,107,900 days of care, respectively, with an estimated direct cost of $5.7 to $7.4 billion and $0.89 to $1.07 billion, respectively. Estimated national costs of inpatient care for HIV infection or tuberculosis or both totaled $6.4 to $8.1 billion, 5% of which was for patients with both HIV infection and tuberculosis.
This is the first study to use a nationally representative sample of hospitals, combined with cost data, to estimate hospitalizations and their costs for HIV and tuberculosis care. Our findings suggest that the convergence of the HIV and tuberculosis epidemics has had an increasing effect on morbidity and the cost of care among young adults in the United States. The increasing prevalence of comorbidity of HIV infection and tuberculosis in inpatients underscores the need for strict infection control of tuberculosis on the part of hospitals, increased attention to prevention, and early identification and treatment of HIV infection, and tuberculosis to reduce morbidity, hospitalizations, and the cost of care.
评估人类免疫缺陷病毒（HIV）感染和结核病对住院率及护理费用的影响。
全国医院出院调查，这是一项对美国非联邦短期住院医院出院情况具有全国代表性的调查，以及全州范围的计费信息。
1985 - 1990年期间年龄在15至44岁、列出HIV感染诊断（n = 418,200）或活动性结核病诊断（n = 77,700）的患者。
1985 - 1990年期间，与HIV感染相关的住院率增长了六倍，从每10万人中的18例增至102例；1988 - 1990年期间，与结核病相关的住院率增长了两倍，从每10万人中的8例增至16例。HIV感染患者中结核病的患病率从1985 - 1988年的2.4%增至1989 - 1990年的5.1%（P = 0.003）。结核病患者中HIV感染的患病率从1985 - 1988年的11%增至1989年的28%，1990年增至39%（P < 0.001）。肺外结核患者中HIV感染比肺结核患者更普遍（31%对18%）（P = 0.01）。住院时间的增加与结核病和HIV感染均相关。1985年至1990年，HIV和结核病住院患者的住院护理费用分别增长了7.7倍和3.2倍。在此期间，HIV和结核病住院分别导致579.3万天和110.79万天的护理，估计直接费用分别为57亿至74亿美元和8.9亿至10.7亿美元。估计全国HIV感染或结核病或两者的住院护理费用总计64亿至81亿美元，其中5%用于同时感染HIV和结核病的患者。
这是第一项使用具有全国代表性的医院样本并结合成本数据来估计HIV和结核病护理的住院率及其成本的研究。我们的研究结果表明，HIV和结核病流行的趋同对美国年轻人的发病率和护理成本产生了越来越大的影响。住院患者中HIV感染和结核病合并症患病率的增加凸显了医院对结核病进行严格感染控制、加强预防关注以及早期识别和治疗HIV感染及结核病以降低发病率、住院率和护理成本的必要性。
