title: Risk factors associated with inpatient hospital utilization in HIV-positive individuals and relationship to HIV care engagement.
abstract: BACKGROUND
  Prompt linkage to HIV primary care may reduce the need for inpatient hospitalization.
  
  
  METHODS
  Retrospective cohort study of South Carolina HIV-infected individuals diagnosed from January 1986 to December 2006 who utilized 62 inpatient facilities from (January 2007 to June 2010). Suboptimal primary care engagement was defined as <2 reports of a CD4T-cell count or viral load value to surveillance in each calendar year from January 2007 to June 2010. Multivariable logistic regression explored associations of HIV primary care engagement with inpatient hospitalization after accounting for sociodemographic characteristics and disease stage. Poisson and negative binominal regression examined primary care engagement, sociodemographic characteristics, and disease stage on frequency of inpatient hospitalization and total inpatient days.
  
  
  RESULTS
  Individuals presenting to the hospital with an AIDS-defining illness had greater risk of suboptimal HIV primary care engagement [adjusted odds ratio (aOR) = 1.58; 95% confidence interval (CI): 1.23 to 2.04] more inpatient hospitalizations (incidence rate ratio [IRR] = 1.74; 95% CI: 1.65 to 1.83) and inpatient days (IRR = 2.17; 95%CI: 2.00 to 2.36). Blacks demonstrated greater suboptimal care risk (aOR = 1.61; 95% CI: 1.15 to 2.25), more inpatient visits (IRR = 1.09; 95% CI: 1.01 to 1.17), and inpatient days (IRR = 1.21; 95% CI: 1.09 to 1.34). Medicare protected against suboptimal primary care engagement (aOR = 0.66; 95% CI: 0.46 to 0.95) but was associated with more hospitalizations (IRR = 1.09; 95% CI: 1.01 to 1.18). AIDS disease stage was associated with decreased suboptimal care risk (AIDS ≤ 1 year, aOR = 0.05; 95% CI: 0.02 to 0.12; AIDS > 1 year, aOR = 0.11; 95% CI: 0.06 to 0.20) but more hospitalizations (AIDS ≤1 year, IRR = 1.12; 95% CI: 1.04 to 1.21; AIDS > 1 year, IRR = 1.12; 95% CI: 1.04 to 1.21) and inpatient days (AIDS ≤ 1 year, IRR = 1.22; 95% CI: 1.08 to 1.37; AIDS >1 year, IRR = 1.35; 95% CI: 1.21 to 1.50).
  
  
  CONCLUSIONS
  Disease stage, race, and insurance status strongly influence HIV primary care engagement and inpatient hospitalization. Admissions may be related to general medical conditions, substance abuse, or antiretroviral therapy.
authors.affiliation: Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Jelani C
authors.initials: JC
authors.lastname: Kerr
authors.forename: Terri G
authors.initials: TG
authors.lastname: Stephens
authors.forename: James J
authors.initials: JJ
authors.lastname: Gibson
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Duffus
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013022:South Carolina; D055815:Young Adult