Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005–2015

Abstract

Background To assess the possible impact of antiretroviral therapy improvements, aging, and comorbidities, we examined trends in all-cause and cause-specific hospitalization rates among persons with HIV (PWH) from 2005 to 2015. Methods In six clinical cohorts, we followed PWH in care (≥1 outpatient CD4 count or HIV viral load [VL] every 12 months) and categorized ICD codes of primary discharge diagnoses using modified Clinical Classifications Software. Poisson regression estimated hospitalization rate ratios for calendar time trends, adjusted for demographics, HIV risk factor, and annually-updated age, CD4, and VL. Results Among 28 057 patients (125 724 person-years), from 2005 to 2015, the median CD4 increased from 389 to 580 cells/µL and virologic suppression from 55% to 85% of patients. Unadjusted all-cause hospitalization rates decreased from 22.3 per 100 person-years in 2005 (95% CI 20.6-24.1) to 13.0 in 2015 (12.2-14.0). Unadjusted rates decreased for almost all diagnostic categories. Adjusted rates decreased for all-cause, cardiovascular, and AIDS-defining conditions, increased for non-AIDS-defining infection, and were stable for most other categories. Conclusions Among PWH with increasing CD4 counts and viral suppression, unadjusted hospitalization rates decreased for all-cause and most cause-specific hospitalizations, despite the potential effects of aging, comorbidities, and cumulative exposure to HIV and antiretrovirals.

Prospective association of social circumstance, socioeconomic, lifestyle and mental health factors with subsequent hospitalisation over 6–7 year follow up in people living with HIV

“…This may underestimate associations for factors likely to change over time such as HIV-related clinical factors, adverse lifestyle factors and mental health symptoms. The rate of hospitalisation of 5.8/100 person-years in our study population was lower than in some other recent studies in other high income settings [ 13 , [35] , [36] , [37] ]. Our study population had a high median CD4 count (621 cells/μl) and included a low proportion of individuals with recent diagnosis (3.6% of individuals were within their first year after diagnosis at baseline) for whom hospitalisation rates are particularly high [6] .…”

Racial, ethnic, and gender disparities in hospitalizations among persons with HIV in the United States and Canada, 2005–2015

“…Recent studies in Illinois, North Carolina, and New York City also reported higher hospitalization rates for women compared with men and Black compared with White PWH [18][19][20]. A previous NA-ACCORD analysis found a small decrease in adjusted rates over time overall [27]. In this study, there was no change in adjusted rates stratified by race, ethnicity, and gender.…”

Prospective Association of Social Circumstance, Socioeconomic, Lifestyle and Mental Health Factors with Subsequent Hospitalisation Over 6-7 Year Follow Up in People Living with HIV

“…This may underestimate associations for factors likely to change over time such as HIV-related clinical factors, adverse lifestyle factors and mental health symptoms. The rate of hospitalisation of 5.8/100 person-years in our study population was lower than in some other recent studies in other high income settings [13,[35][36][37]. Our study population had a high median CD4 count (621 cells/ml) and included a low proportion of individuals with recent diagnosis (3.6% of individuals were within their first year after diagnosis at baseline) for whom hospitalisation rates are particularly high [6].…”