Racial and gender disparities in receipt of highly active antiretroviral therapy persist in a multistate sample of HIV patients in 2001
Racial and gender disparities in receipt of highly active antiretroviral therapy persist in a multistate sample of HIV patients in 2001
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DOI：
10.1097/00126334-200501010-00017
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发表时间：
2005-01-01
影响因子：
3.6
通讯作者：
Mathews, WC
中科院分区：
文献类型：
--
作者：
Gebo, KA;Fleishman, JA;Mathews, WC
背景：20世纪90年代中期的国家数据表明，许多符合条件的患者没有接受高效抗逆转录病毒治疗（HAART），并且在接受HAART方面存在种族和性别差异。我们调查了2001年HAART使用的人口差异是否持续存在，门诊治疗是否与HAART使用相关。方法：从美国HIV研究网络（HIVRN）的10个HIV初级保健站点收集人口统计学、临床和药物使用数据。使用多变量逻辑回归，我们检查了与HAART接受相关的人口统计学和临床差异以及门诊使用与HAART的关联。结果：在我们2001年的队列中，84%的患者接受了HAART治疗，66%的患者在2001年（CY）有4次或更多的门诊就诊。2001年，在CD4计数低于350细胞/mm(3)的患者中，91%接受了HAART治疗；在I CD4检测结果低于350 cells/mm(3)的患者中，82%接受HAART治疗；CD4细胞计数不低于350细胞/毫米(3)的77%接受了HAART治疗。多因素分析调整护理地点：年龄0 ~ 40岁（调整优势比[AOR] = 1.13）、男性（AOR = 1.23）、医疗补助覆盖率（AOR = 1）。16)、医疗保险覆盖率（AOR = 1）。73)， 1个或更多的CD4计数小于350细胞/毫米(3)(AOR = 1.33)，以及一年内有4次或更多门诊就诊（or = 1.34）与HAART的可能性增加显著相关。非裔美国人（优势比[OR] = 0.84）和有注射吸毒危险因素的人（OR = 0.86）接受HAART治疗的可能性较小。结论：尽管自20世纪90年代中期以来HAART的总体流行率有所增加，但HAART接受的人口差异仍然存在。我们的结果支持尝试增加对未充分利用群体的护理和门诊就诊频率，以及加大努力减少妇女、非裔美国人和注射吸毒者（IDUs）的持续差异。
Background: National data from the mid-1990s demonstrated that many eligible patients did not receive highly active antiretroviral therapy (HAART) and that racial and gender disparities existed in HAART receipt. We examined whether demographic disparities in the use of HAART persist in 2001 and if outpatient care is associated with HAART utilization.Methods: Demographic, clinical, and pharmacy utilization data were collected from 10 US HIV primary care sites in the HIV Research Network (HIVRN). Using multivariate logistic regression, we examined demographic and clinical differences associated with receipt of HAART and the association of outpatient utilization with HAART.Results: In our cohort in 2001, 84% of patients received HAART and 66% had 4 or more outpatient visits during calendar year (CY) 2001. Of those with 2 or more CD4 counts below 350 cells/mm(3) in 2001, 91% received HAART; 82% of those with I CD4 test result below 350 cells/mm(3) received HAART; and 77% of those with no CD4 counts below 350 cells/mm(3) received HAART. Adjusting for care site in multivariate analyses, age >40 years (adjusted odds ratio [AOR] = 1.13), male gender (AOR = 1.23), Medicaid coverage (AOR = 1. 16), Medicare coverage (AOR = 1. 73), having I or more CD4 counts less than 350 cells/mm(3) (AOR = 1.33), and having 4 or more outpatient visits in a year (OR = 1.34) were significantly associated with an increased likelihood of HAART. African Americans (odds ratio [OR] = 0.84) and those with an injection drug use risk factor (OR = 0.86) were less likely to receive HAART.Conclusions: Although the overall prevalence of HAART has increased since the mid-1990s, demographic disparities in HAART receipt persist. Our results support attempts to increase access to care and frequency of outpatient visits for underutilizing groups as well as increased efforts to reduce persistent disparities in women, African Americans, and injection drug users (IDUs).