Is there a race-based disparity in the survival of veterans with HIV?
BACKGROUND
Disparities in survival for black patients with HIV in the United States have been reported. The VA is an equal access health care system.


OBJECTIVE
To determine whether such disparities are present in the VA health care system.


METHODS
Retrospective cohort study using national VA administrative databases.


METHODS
Two thousand three hundred and four white and 3,641 black HIV-infected patients first hospitalized for HIV between October 1, 1996 and September 30, 2000.


METHODS
Thirty-day mortality after first hospitalization with HIV, and subsequent long-term survival. Follow-up ended at death or September 30, 2002. Data were adjusted for age, sex, HIV disease severity, non-HIV-related comorbidities, primary discharge diagnosis, hepatitis C status, and facility effects.


RESULTS
The mean follow-up was 3.2 years. Overall survival was similar for black patients compared with white patients (adjusted hazard ratio 1.09, P=.09). Hospital mortality was 7.0% for black and 6.4% for white patients (P=.35). Adjusted hospital mortality for black patients was similar to that of white patients (odds ratio 1.20, P=.10). Long-term survival after hospitalization did not significantly differ by race (adjusted hazard ratio 1.07, P=.21, for black patients compared with white patients).


CONCLUSIONS
Survival during and after first hospitalization with HIV in the VA did not significantly differ for white and black patients, possibly indicating similar effectiveness of care for HIV. Further research is needed to understand the reasons for the lack of disparities for VA patients with HIV and whether the VA's results could be replicated.
Giordano
Thomas P
TP
Department of Medicine, Baylor College of Medicine, Houston, TX, USA. tpg@bcm.tmc.edu
Morgan
Robert O
RO
Kramer
Jennifer R
JR
Hartman
Christine
C
Richardson
Peter
P
White
Clinton A
CA
Suarez-Almazor
Maria E
ME
El-Serag
Hashem B
HB
D000328:Adult; D044383:Black People; D015658:HIV Infections / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D011287:Prejudice; D044469:Racial Groups; D016019:Survival Analysis; D014481:United States; D014728:Veterans; D044465:White People; D001741:Black or African American