Health care utilization and survival among patients with AIDS in Belo Horizonte, Minas Gerais, Brazil.
A historical cohort study was conducted in three public AIDS referral services in Belo Horizonte, Minas Gerais, to assess the relationship between health care utilization and patient survival following AIDS diagnosis. A review of medical and laboratory records was performed for HIV-infected patients seeking care for the first time in 1989-92. Among 291 patients initially categorized as 'A' [asymptomatic, acute HIV, or persistent generalized lymphadenopathy-PGL] or 'B' [symptomatic, non-'A', or AIDS-indicator conditions] (CDC, 1992) and who progressed to AIDS, 57.0% died. Mortality rate was 34.9 person-months. Overall median survival time following AIDS diagnosis was 14.3 months. Multivariate analysis showed that lack of AZT use (RR=1.87; 95% CI=1.34-2.61), advanced initial staging (RR=1.68; 95% CI=1.20-2.35), 9 or more inpatient days (RR=1.55; 95% CI=1.11-2.17), and intervals between outpatient visits longer than 6 months (RR=0.30; 95%CI= 0.16-0.56) were associated with death. The analysis suggests that: Patients who used health services more often had poorer prognosis; Patients who received AZT survived longer than those who did not; and variables used to assess health care utilization actually express the end of a process involving seeking and obtaining care.
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Departamento de Farmácia Social e Curso de Doutorado em Ciência Animal, Universidade Federal de Minas Gerais, Av. Olegário Maciel 2360, Belo Horizonte, MG 30180-112, Brasil.
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D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality / Q000628:therapy*; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006679:HIV Seropositivity / Q000401:mortality / Q000628:therapy; D015497:HIV-1 / Q000276:immunology; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012959:Socioeconomic Factors; D016019:Survival Analysis; D013997:Time Factors