Trends in Reasons for Hospitalization in a Multisite United States Cohort of Persons Living With HIV, 2001-2008
Trends in Reasons for Hospitalization in a Multisite United States Cohort of Persons Living With HIV, 2001-2008
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DOI：
10.1097/qai.0b013e318246b862
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发表时间：
2012-04-01
影响因子：
3.6
通讯作者：
Gebo, Kelly A.
中科院分区：
文献类型：
--
作者：
Berry, Stephen A.;Fleishman, John A.;Gebo, Kelly A.
简介：在目前的高活性抗逆转录病毒疗法时代，艾滋病毒感染者的共病住院率是unknown.Methods：从2001年至2008年的住院数据，获得了11,645名成年人接受纵向艾滋病毒护理在4个地理位置不同的美国艾滋病毒诊所内的艾滋病毒研究网络。美国医疗保健研究和质量局修改后的临床分类软件将主要ICD-9代码分配到诊断类别中。结果：2001 ~ 2008年，艾滋病定义疾病（ADI）住院率从6.7/100人年下降到2.7/100人年，年发病率比为0.89（0.87，0.91）。在平均发病率>2/100人-年的其他诊断类别中，心血管住院率随时间推移而增加[1.07（1.03，1.11）]，而非艾滋病定义的感染[0.98（0.96，1.00）]、精神科[0.96（0.93，1.00）]和胃肠道/肝脏[0.96（0.92，1.00）]略有下降或稳定。尽管总体上频率较低，但在单变量和多变量分析中，肾和肺入院也随时间推移而增加。在所有诊断类别中，ADI入院的平均住院时间最长，为10.5 days.Discussion：ADI住院治疗近年来持续下降，但仍然相对频繁，住院时间长，可能费用高。慢性终末器官疾病入院率的增加或稳定意味着，护理艾滋病毒感染者的临床医生个人和/或团队需要更广泛的医学知识，需要长期获得治疗这些疾病的药物。
Introduction: Hospitalization rates for comorbid conditions among persons living with HIV in the current highly active antiretroviral therapy era are unknown.Methods: Hospitalization data from 2001 to 2008 were obtained on 11,645 adults receiving longitudinal HIV care at 4 geographically diverse US HIV clinics within the HIV Research Network. Modified clinical classification software from the Agency for Healthcare Research and Quality assigned primary ICD-9 codes into diagnostic categories. Analysis was performed with repeated measures negative binomial regression.Results: During 2001 to 2008, the rate of AIDS-defining illness (ADI) hospitalizations declined from 6.7 to 2.7 per 100 person-years, incidence rate ratio per year, 0.89 (0.87, 0.91). Among the other diagnostic categories with average rates >2 per 100 person-years, cardiovascular hospitalizations increased over time [1.07 (1.03, 1.11)], whereas non-AIDS-defining infection [0.98 (0.96, 1.00)], psychiatric [0.96 (0.93, 1.00)], and gastrointestinal/liver [0.96 (0.92, 1.00)] were slightly decreasing or stable. Although less frequent overall, renal and pulmonary admissions also increased over time in univariate and multivariate analyses. Of all diagnostic categories, ADI admissions had the longest mean length of stay, 10.5 days.Discussion: ADI hospitalizations have continued to decline in recent years but are still relatively frequent and potentially costly given long lengths of stay. Increases or stability in the rates of chronic end-organ disease admissions imply a need for broader medical knowledge among individual clinicians and/or teams who care for persons living with HIV and a need for long-term access to medications for these conditions.