title: Alcohol problems and health care services use in human immunodeficiency virus (HIV)-infected and HIV-uninfected veterans.
abstract: 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.
authors.affiliation: Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. kraemerk1@upmc.edu
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Kraemer
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: McGinnis
authors.forename: Melissa
authors.initials: M
authors.lastname: Skanderson
authors.forename: Robert
authors.initials: R
authors.lastname: Cook
authors.forename: Adam
authors.initials: A
authors.lastname: Gordon
authors.forename: Joseph
authors.initials: J
authors.lastname: Conigliaro
authors.forename: Yujing
authors.initials: Y
authors.lastname: Shen
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: 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