Bozzette S A, Berry S H, Duan N, Frankel M R, Leibowitz A A, Lefkowitz D, Emmons C A, Senterfitt J W, Berk M L, Morton S C, Shapiro M F
RAND Health, Santa Monica, CA, USA.
N Engl J Med. 1998 Dec 24;339(26):1897-904. doi: 10.1056/NEJM199812243392606.
In order to elucidate the medical care of patients with human immunodeficiency virus (HIV) infection in the United States, we randomly sampled HIV-infected adults receiving medical care in the contiguous United States at a facility other than military, prison, or emergency department facility during the first two months of 1996. We interviewed 76 percent of 4042 patients selected from among the patients receiving care from 145 providers in 28 metropolitan areas and 51 providers in 25 rural areas.
During the first two months of 1996, an estimated 231,400 HIV-infected adults (95 percent confidence interval, 162,800 to 300,000) received care. Fifty-nine percent had the acquired immunodeficiency syndrome according to the case definition of the Centers for Disease Control and Prevention, and 91 percent had CD4+ cell counts of less than 500 per cubic millimeter. Eleven percent were 50 years of age or older, 23 percent were women, 33 percent were black, and 49 percent were men who had had sex with men. Forty-six percent had incomes of less than $10,000 per year, 68 percent had public health insurance or no insurance, and 30 percent received care at teaching institutions. The estimated annual direct expenditures for the care of the patients seen during the first two months of 1996 were $5.1 billion; the expenditures for the estimated 335,000 HIV-infected adults seen at least as often as every six months were $6.7 billion, which is about $20,000 per patient per year.
In this national survey we found that most HIV-infected adults who were receiving medical care had advanced disease. The patient population was disproportionately male, black, and poor. Many Americans with diagnosed or undiagnosed HIV infection are not receiving medical care at least as often as every six months. The total cost of medical care for HIV-infected Americans accounts for less than 1 percent of all direct personal health expenditures in the United States.
为阐明美国人类免疫缺陷病毒（HIV）感染者的医疗情况，我们于1996年头两个月在美国本土（不包括军事、监狱或急诊科机构）对接受医疗护理的HIV感染成年人进行了随机抽样。我们对从28个大都市地区的145个医疗服务提供者以及25个农村地区的51个医疗服务提供者处接受治疗的4042名患者中的76%进行了访谈。
在1996年头两个月，估计有231,400名HIV感染成年人接受了治疗（95%置信区间为162,800至300,000）。根据疾病控制与预防中心的病例定义，59%的患者患有获得性免疫缺陷综合征，91%的患者CD4 +细胞计数低于每立方毫米500个。11%的患者年龄在50岁及以上，23%为女性，33%为黑人，49%为男同性恋者。46%的患者年收入低于10,000美元，68%的患者有公共医疗保险或无保险，30%的患者在教学机构接受治疗。1996年头两个月接受治疗的患者的估计年度直接支出为51亿美元；估计每六个月至少接受一次治疗的335,000名HIV感染成年人的支出为67亿美元，即每名患者每年约20,000美元。
在这项全国性调查中，我们发现大多数接受医疗护理的HIV感染成年人病情已发展到晚期。患者群体中男性、黑人和贫困人口比例过高。许多已确诊或未确诊HIV感染的美国人未每六个月至少接受一次医疗护理。美国HIV感染患者的医疗护理总费用占美国所有直接个人医疗支出的比例不到1%。
