title: The effects of immune status and race on health service use among people with HIV disease.
abstract: OBJECTIVE
  The purpose of this study was to examine the relationship between CD4 lymphocyte count and health service use, and to determine whether differences in the rates of service use between Whites and people of color could be identified.
  
  
  METHODS
  Medical records for 571 HIV-infected individuals were analyzed. Incidence rates and relative rates across CD4 strata (defined by cell counts) were calculated for inpatient and outpatient events. Rate ratios comparing people of color with Whites were estimated within strata, adjusting for confounding factors using a Mantel-Haenszel pooling procedure.
  
  
  RESULTS
  Both inpatient and outpatient service use increased over progressively lower levels of CD4 counts. Within each CD4 stratum and controlling for other factors, White participants had more HIV clinic visits and fewer admissions than people of color. Among participants with fewer than 51 CD4 cells per cubic millimeter, people of color were admitted 20% more often, had 35% more inpatient days per person-year, and had only 74% as many HIV clinic visits as their White counterparts.
  
  
  CONCLUSIONS
  These results indicate that CD4 lymphocyte count is strongly associated with increased usage of health services. People of color with HIV disease are more likely than similar Whites to be admitted to the hospital and less likely to use outpatient care.
authors.affiliation: Brown University's AIDS Program, Providence, RI.
authors.forename: J D
authors.initials: JD
authors.lastname: Piette
authors.forename: V
authors.initials: V
authors.lastname: Mor
authors.forename: K
authors.initials: K
authors.lastname: Mayer
authors.forename: S
authors.initials: S
authors.lastname: Zierler
authors.forename: T
authors.initials: T
authors.lastname: Wachtel
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015982:Bias; D015496:CD4-Positive T-Lymphocytes; D015986:Confounding Factors, Epidemiologic; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology / Q000523:psychology*; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D007958:Leukocyte Count; D008297:Male; D008485:Medical Audit; D008873:Mid-Atlantic Region / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data*; D044469:Racial Groups; D012720:Severity of Illness Index; D015144:Southeastern United States / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D013781:Texas / Q000453:epidemiology; D014861:Washington / Q000453:epidemiology