Rural residence is associated with delayed care entry and increased mortality among veterans with human immunodeficiency virus infection.
Rural residence is associated with delayed care entry and increased mortality among veterans with human immunodeficiency virus infection.
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DOI：
10.1097/mlr.0b013e3181ef60c2
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发表时间：
2010-12
期刊：
影响因子：
3
通讯作者：
Justice A
中科院分区：
文献类型：
--
作者：
Ohl M;Tate J;Duggal M;Skanderson M;Scotch M;Kaboli P;Vaughan-Sarrazin M;Justice A
农村艾滋病毒感染者在获得护理方面面临许多障碍，但人们对艾滋病毒结果的城乡差异知之甚少。确定农村居住与艾滋病毒结果之间的关联。回顾性队列研究1998-2006年期间在退伍军人管理局（VA）启动艾滋病毒护理的人员死亡率，死亡率随访至2008年。农村居住地是使用农村城市通勤区代码确定的。我们确定了8489人开始艾滋病毒护理在VA没有证据的联合抗逆转录病毒治疗（cART）使用在护理入口，其中705（8.3%）是农村。全因死亡率。在开始接受治疗时，农村人比城市人更不可能有吸毒问题（10.6%对19.5%，P < 0.001）或丙型肝炎（34.3%对41.2%，P = 0.001），但有更晚期的HIV感染（中位数CD 4：186对246，P < 0.001）。在接受治疗后2年，5874人开始了cART治疗（农村528人[74.9%]，城市5346人[68.7%]，P = 0.001），有1022人死亡（农村108人[15.3%]，城市914人[11.7%]，P = 0.004）。农村与城市相比的死亡风险比为1.34（95%置信区间：1.05-1.69）。在调整进入护理时的HIV严重程度（CD 4和AIDS定义疾病）后，风险比降至1.18（95%置信区间：0.93-1.50），在调整年龄、进入护理时的HIV严重程度、物质使用、B或C型肝炎诊断和cART启动的模型中，风险比为1.17（95%置信区间：0.92-1.50）。与城市退伍军人相比，较晚进入护理机构导致农村退伍军人感染艾滋病毒的死亡率增加。未来的研究应探讨的人，护理系统，和社区一级的决定因素，对农村艾滋病毒感染者的后期护理进入。
Rural persons with human immunodeficiency virus (HIV) face many barriers to care, but little is known about rural-urban variation in HIV outcomes. To determine the association between rural residence and HIV outcomes. Retrospective cohort study of mortality among persons initiating HIV care in Veterans Administration (VA) during 1998–2006, with mortality follow-up through 2008. Rural residence was determined using Rural Urban Commuting Area codes. We identified 8489 persons initiating HIV care in VA with no evidence of combination antiretroviral therapy (cART) use at care entry, of whom 705 (8.3%) were rural. All-cause mortality. At care entry, rural persons were less likely than urban persons to have drug use problems (10.6% vs. 19.5%, P < 0.001) or hepatitis C (34.3% vs. 41.2%, P = 0.001), but had more advanced HIV infection (median CD4: 186 vs. 246, P < 0.001). By 2 years after care entry, 5874 persons had initiated cART (528 rural [74.9%] and 5346 urban [68.7%], P = 0.001), and there were 1022 deaths (108 rural [15.3%] and 914 urban [11.7%], P = 0.004). The mortality hazard ratio for rural persons compared with urban was 1.34 (95% confidence interval: 1.05–1.69). The hazard ratio decreased to 1.18 (95% confidence interval: 0.93–1.50) after adjustment for HIV severity (CD4 and AIDS-defining illnesses) at care entry, and was 1.17 (95% confidence interval: 0.92–1.50) in a model adjusting for age, HIV severity at care entry, substance use, hepatitis B or C diagnoses, and cART initiation. Later entry into care drives increased mortality for rural compared with urban veterans with HIV. Future studies should explore the person, care system, and community-level determinants of late care entry for rural persons with HIV.