Piette J D, Mor V, Mayer K, Zierler S, Wachtel T
Brown University's AIDS Program, Providence, RI.
Am J Public Health. 1993 Apr;83(4):510-4. doi: 10.2105/ajph.83.4.510.
The purpose of this study was to examine the relationship between CD4 lymphocyte count and health service use, and to determine whether differences in the rates of service use between Whites and people of color could be identified.
Medical records for 571 HIV-infected individuals were analyzed. Incidence rates and relative rates across CD4 strata (defined by cell counts) were calculated for inpatient and outpatient events. Rate ratios comparing people of color with Whites were estimated within strata, adjusting for confounding factors using a Mantel-Haenszel pooling procedure.
Both inpatient and outpatient service use increased over progressively lower levels of CD4 counts. Within each CD4 stratum and controlling for other factors, White participants had more HIV clinic visits and fewer admissions than people of color. Among participants with fewer than 51 CD4 cells per cubic millimeter, people of color were admitted 20% more often, had 35% more inpatient days per person-year, and had only 74% as many HIV clinic visits as their White counterparts.
These results indicate that CD4 lymphocyte count is strongly associated with increased usage of health services. People of color with HIV disease are more likely than similar Whites to be admitted to the hospital and less likely to use outpatient care.
本研究旨在探讨CD4淋巴细胞计数与医疗服务利用之间的关系，并确定能否识别白人与有色人种在医疗服务利用率上的差异。
对571名艾滋病毒感染者的病历进行分析。计算各CD4分层（按细胞计数定义）的住院和门诊事件的发病率及相对率。在各分层内估计有色人种与白人的率比，并采用Mantel-Haenszel合并程序对混杂因素进行调整。
随着CD4计数水平逐渐降低，住院和门诊服务的利用均增加。在每个CD4分层内并控制其他因素后，白人参与者的艾滋病毒门诊就诊次数多于有色人种，而住院次数少于有色人种。在每立方毫米CD4细胞少于51个的参与者中，有色人种的住院率高出20%，每人每年的住院天数多出35%，而艾滋病毒门诊就诊次数仅为白人参与者的74%。
这些结果表明，CD4淋巴细胞计数与医疗服务利用的增加密切相关。感染艾滋病毒的有色人种比类似的白人更有可能住院，而使用门诊护理的可能性更小。
