title: Does access to health care impact survival time after diagnosis of AIDS?
abstract: Lack of access to health care is often blamed for poor health outcomes, but this effect is not supported by existing HIV/AIDS literature. The authors examined the association between access to care and survival time after progression to AIDS, using survival analysis methods. This study combined data from two CDC sponsored studies of HIV-infected persons, a cross-sectional interview study and a longitudinal medical record review study. Study subjects included 752 persons who progressed to AIDS before December 31, 1999, and were patients at either of two major HIV care facilities in Detroit, MIchigan. Separate statistical models were used to test associations between survival time after meeting the criteria for AIDS and two indicators of access to health care: (1) perceived access to health care and (2) health care utilization patterns. Perceived access was not associated with survival time after AIDS, but patterns of health care utilization were significantly associated with survival time after AIDS (HR = 2.04, p < 0.001). Individuals who received a greater proportion of their care in the ER had a worse survival prognosis than those who received more of their health care in an outpatient clinic setting. It is crucial that we provide HIV-infected populations with tools that enable them to access a regular source of health care.
authors.affiliation: Michigan Department of Community Health, HIV/AIDS Surveillance Section, Detroit, Michigan, USA. montgomeryjp@michigan.gov
authors.forename: Jolynn Pratt
authors.initials: JP
authors.lastname: Montgomery
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Gillespie
authors.forename: Anne C
authors.initials: AC
authors.lastname: Gentry
authors.forename: Eve D
authors.initials: ED
authors.lastname: Mokotoff
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Crane
authors.forename: Sherman A
authors.initials: SA
authors.lastname: James
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000191:economics / Q000401:mortality*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D018450:Disease Progression; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis