Health care of children and adults with acquired immunodeficiency syndrome. A population-based analysis.
OBJECTIVE
To compare the use of medical services by pediatric and adult patients with acquired immunodeficiency syndrome (AIDS) in the 6 months before and after the diagnosis of AIDS when demand for care is often high and to study the influence of human immunodeficiency virus specialty care on survival of pediatric patients.


METHODS
Retrospective analysis of Medicaid files.


METHODS
New York State Medicaid Program.


METHODS
A cohort identified as having AIDS from 1985 through 1990 and enrolled on Medicaid from birth or 1 year or more before diagnosis. Because of differing prognoses, 3 groups were studied by age at the time that AIDS was diagnosed: infants younger than 6 months, children aged 6 months to 12 years, and adults aged 13 to 60 years.


METHODS
Frequencies of any service use and, among users, monthly rates of services. From Cox proportional hazards models, the adjusted hazard of death for human immunodeficiency virus specialty ambulatory care.


RESULTS
Nearly all infants (n = 122) were hospitalized before and after the diagnosis of AIDS was made--the most of all groups. After diagnosis, only 81% of older children (n = 612) were hospitalized vs 93% of infants and 90% of adults (n = 5602). Hospitalized children had a median of only 3.3 inpatient days per month vs 12.3 and 7.8 inpatient days for infants and adults, respectively. Of older children, 45% used the emergency department vs 33% of adults. Human immunodeficiency virus specialty care for infants and children was associated with a 40% lower risk of death after the diagnosis of AIDS.


CONCLUSIONS
In this AIDS cohort, infants had the greatest use of inpatient care, and older children used the emergency department more than adults. The finding of improved survival for infants and children with human immunodeficiency virus specialty care warrants further study in more recent years.
Turner
B J
BJ
Division of General Internal Medicine, Jefferson Medical College, Philadelphia, Pa, USA.
Eppes
S C
SC
Markson
L E
LE
McKee
L J
LJ
Fanning
T R
TR
Pantell
R H
RH
D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009518:New York; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014481:United States