title: Impact of immunosuppression on health care use by men in the Multicenter AIDS Cohort Study (MACS).
abstract: The effects of human immunodeficiency virus type 1 (HIV-1) serostatus, AIDS, and level of immunosuppression on health service use were examined in the Multicenter AIDS Cohort Study. Data on self-reported hospitalizations, outpatient medical services (non-emergency room) and emergency room care during the preceding 6 months were collected for 3,447 homosexual/bisexual men returning for their 14th and/or 15th semiannual visits in Chicago, Baltimore, Los Angeles, and Pittsburgh. AIDS-free seropositive men with CD4+ cells < 200/microliters were more likely to be hospitalized [odds ratio (OR) = 2.3, 95% confidence limits (CL) = 1.4, 3.8] and use outpatient medical care (OR = 7.9, 95% CL = 4.9, 12.6), compared with seronegative men. Increased outpatient care was initiated at the earliest stages of HIV-1 infection, even when CD4+ cells were > 500/microliter. Dramatic increases in outpatient care for each level of immunosuppression were observed. HIV-1-related symptoms were associated with increased hospitalizations (OR = 4.8, 95% CL = 3.2, 7.3), use of outpatient medical services (OR = 3.3, 95% CL = 1.9, 5.6), and emergency room care (OR = 3.1, 95% CL = 2.1, 4.6). Persons with AIDS and < or = 50 CD4+ cells/microliter most likely to be hospitalized (OR = 8.1; 95% CL = 4.4, 14.9). No significant difference (p > 0.05) in emergency room use was observed according to HIV-1 serostatus, AIDS, or immunosuppression, after adjusting for insurance and clinical symptoms. To the extent that CD4+ cell counts are used as one of the criteria for an AIDS diagnosis and such a diagnosis broadens available benefits to persons with HIV disease, the pattern of health care services described here will be important for health care providers and planners.
authors.affiliation: Health Policy Institute, Graduate School of Public Health, University of Pittsburgh, PA 15261.
authors.forename: S L
authors.initials: SL
authors.lastname: Zucconi
authors.forename: L P
authors.initials: LP
authors.lastname: Jacobson
authors.forename: L K
authors.initials: LK
authors.lastname: Schrager
authors.forename: N E
authors.initials: NE
authors.lastname: Kass
authors.forename: J R
authors.initials: JR
authors.lastname: Lave
authors.forename: C A
authors.initials: CA
authors.lastname: Carson
authors.forename: H
authors.initials: H
authors.lastname: Morgenstern
authors.forename: P S
authors.initials: PS
authors.lastname: Arno
authors.forename: N M
authors.initials: NM
authors.lastname: Graham
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000191:economics*; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001727:Bisexuality; D015496:CD4-Positive T-Lymphocytes; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D006679:HIV Seropositivity / Q000191:economics*; D006296:Health Services / Q000706:statistics & numerical data*; D006716:Homosexuality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D007348:Insurance, Health; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012044:Regression Analysis; D014481:United States