Distance from care predicts in-hospital mortality in HIV-infected patients with severe sepsis from rural and semi-rural Virginia, USA

Abstract

There are few data regarding outcomes from severe sepsis for HIV-infected patients living in rural or semi-rural settings. We aim to describe the characteristics and predictors of mortality in HIV-infected patients admitted with severe sepsis to the University of Virginia located in semi-rural Charlottesville, Virginia, USA. We queried the University of Virginia Clinical Data Repository for cases with ICD-9 codes that included: (1) infection, (2) acute organ dysfunction, and (3) HIV infection. We reviewed each case to confirm the presence of HIV infection and severe sepsis. We recorded socio-demographic, clinical, and laboratory data. We used a generalised linear mixed-effects model to assess pre-specified predictors of mortality. We identified 74 cases of severe sepsis in HIV-infected patients admitted to University of Virginia since 2001. The median (IQR) age was 44 (36-49), 32 (43%) were women, and 56 (76%) were from ethnic minorities. The median (IQR) CD4+ T-cell count was 81 (7-281) cells/µL. In-hospital mortality was 20%. When adjusted for severity of illness and respiratory failure, patients who lived >40 miles away from care or had a CD4+ T cell count <50 cells/µL had > four-fold increased risk of death compared to the rest of the study population (AOR = 4.18, 95% CI: 1.09-16.07, p = 0.037; AOR = 4.33, 95% CI: 1.15-16.29, p = 0.03). In HIV-infected patients from rural and semi-rural Virginia with severe sepsis, mortality was increased in those that lived far from University of Virginia or had a low CD4+ T cell counts. Our data suggest that rural HIV-infected patients may have limited access to care, which predisposes them to critical illness and a high associated mortality.

Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea

“…Many studies have shown the reverse associations between the survival probability of time-sensitive cardiovascular disease and geographical distance to emergency medical centers [8-10, 12, 27]. The adverse mortality effects of a long travel distance to hospital were also observed in cases of sepsis and injuries (e.g., traumatic brain injury) [11,28,29]. In addition, our risk-adjusted analysis also suggested that distance decay affects the survival probability of these five ECSCs.…”

Distance Between Home and the Admitting Hospital and Its Effect on Survival of Low Socioeconomic Status Population With Staphylococcus aureus Bacteremia

“…Driving is the main source of transportation for Los Angeles County residents, yet 31% of our SES quintile-1 cohort lived in neighborhoods where an estimated quarter of residents lack access to a vehicle. 13 Previous reports similarly found higher mortality risk among patients with severe sepsis who lived far from care 30 or who resided in a medically underserved area. 31 Lack of access to ambulatory services may also lead to a high frequency of emergency department visits, especially in the homeless population.…”

Associations between treatment burden, self-reported treatment qualities, antiretroviral therapy obtainment, and health-related quality of life among Ugandan PLWH

“…Prior studies also had noted the importance of distance to ART facility. For instance, several prior studies found distance to health facility influenced uptake of prevention regimens [44], high mortality [45], and visiting times [46]. A study conducted in rural Malawi suggested that reduction in travel distance could achieve the ART coverage and increase access to ART [47].…”