Alcohol problems and health care services use in human immunodeficiency virus (HIV)-infected and HIV-uninfected veterans.
BACKGROUND
Although alcohol problems are common in human immunodeficiency virus (HIV)-infected patients, their impact on health care services use in HIV-infected patients is not well understood.


OBJECTIVE
We sought to examine the association between alcohol problems and health care services use in HIV-infected and HIV-uninfected patients.


METHODS
We undertook a prospective analysis of 16,048 HIV-infected veterans and 32,096 age-, race-, gender-, and region-matched HIV-uninfected controls identified through the national Veterans Affairs electronic administrative medical record database. We identified subjects with alcohol problems using ICD-9-CM codes for alcohol diagnoses and/or alcohol-related complications.


METHODS
We measured outpatient visits, emergency department visits, and inpatient hospitalizations over 12 months of follow-up.


RESULTS
In adjusted analyses, HIV-infected veterans with alcohol problems were significantly more likely than HIV-uninfected veterans without alcohol problems to have at least 1 outpatient visit and at least 1 inpatient hospitalization and, among those with any health services use, to have significantly greater rates for outpatient visits (Incidence rate ratio [IRR] 2.17; 95% confidence interval [CI] 2.06-2.28; P < 0.001), emergency department visits (IRR 1.46; 95% CI 1.35-1.58; P < 0.001), and inpatient hospitalizations (IRR 1.46; 95% CI 1.30-1.64; P < 0.001). The incidence rates for outpatient visits, mental health visits, emergency department visits, and inpatient hospitalizations were significantly higher in HIV-infected veterans with alcohol problems than in HIV-infected veterans without alcohol problems. We did not find a consistent interaction effect between alcohol problems and HIV status.


CONCLUSIONS
Alcohol problems are associated with greater outpatient, emergency department, and inpatient health care utilization in HIV-infected and HIV-uninfected veterans. However, alcohol does not appear to have a stronger effect on health services use in HIV-infected veterans compared with HIV-uninfected veterans.
Kraemer
Kevin L
KL
Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. kraemerk1@upmc.edu
McGinnis
Kathleen A
KA
Skanderson
Melissa
M
Cook
Robert
R
Gordon
Adam
A
Conigliaro
Joseph
J
Shen
Yujing
Y
Fiellin
David A
DA
Justice
Amy C
AC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D006679:HIV Seropositivity; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013781:Texas; D014728:Veterans