title: Socio-economic- and sex-related disparities in rates of hospital admission among patients with HIV infection in Ontario: a population-based study.
abstract: BACKGROUND
  Among people living with HIV infection in the era of combination antiretroviral therapy (cART), admission to hospital may indicate inadequate community-based care. As such, population-based assessments of the utilization of inpatient services represent a necessary component of evaluating the quality of HIV-related care.
  
  
  METHODS
  We used a validated algorithm to search Ontario's administrative health care databases for all persons living with HIV infection aged 18 years or older between 1992/93 and 2008/09. We then conducted a population-based study using time-series and longitudinal analyses to first quantify the immediate effect of cART on hospital admission rates and then analyze recent trends (for 2002/03 to 2008/09) in rates of total and HIV-related admissions.
  
  
  RESULTS
  The introduction of cART in 1996/97 was associated with more pronounced reductions in the rate of hospital admissions among men than among women (for total admissions, -89.9 v. -60.5 per 1000 persons living with HIV infection, p = 0.003; for HIV-related admissions, -56.9 v. -36.3 per 1000 persons living with HIV infection, p < 0.001). Between 2002/03 and 2008/09, higher rates of total hospital admissions were associated with female sex (adjusted relative rate [RR] 1.15, 95% confidence interval [CI] 1.05-1.27) and low socio-economic status (adjusted RR 1.21, 95% CI 1.14-1.29). Higher rates of HIV-related hospital admission were associated with low socio-economic status (adjusted RR 1.30, 95% CI 1.17-1.45). Recent immigrants had lower rates of both total admissions (adjusted RR 0.70, 95% CI 0.61-0.80) and HIV-related admissions (adjusted RR 0.77, 95% CI 0.61-0.96).
  
  
  CONCLUSIONS
  We observed important socio-economic- and sex-related disparities in rates of hospital admission among people with HIV living in Ontario, Canada.
authors.affiliation: Department of Family and Community Medicine at St. Michael’s Hospital and an Assistant Professor in the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada. tantoniou@smh.ca
authors.forename: Tony
authors.initials: T
authors.lastname: Antoniou
authors.forename: Brandon
authors.initials: B
authors.lastname: Zagorski
authors.forename: Mona R
authors.initials: MR
authors.lastname: Loutfy
authors.forename: Carol
authors.initials: C
authors.lastname: Strike
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003710:Demography; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000628:therapy; D006296:Health Services / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D009864:Ontario / Q000453:epidemiology; D012042:Registries; D018570:Risk Assessment; D012737:Sex Factors; D012959:Socioeconomic Factors