title: HIV disease burden, cost, and length of stay in Portuguese hospitals from 2000 to 2010: a cross-sectional study.
abstract: BACKGROUND
  The number of HIV-related hospitalizations has decreased worldwide in recent years owing to the availability of highly active antiretroviral therapy. However, the change in HIV-related hospitalizations in Portugal has not been studied. Using comprehensive hospital discharge data from mainland Portuguese hospitals, we examined trends in HIV-related inpatient admissions, length of stay (LOS), Elixhauser comorbidity measures, in-hospital mortality, and mean cost from 2000 to 2010.
  
  
  METHODS
  The hospital administrative data from inpatient admissions and discharges at 75 public acute care hospitals in the Portuguese National Health Service from 2000 to 2010 were included. HIV-related admissions were identified using the International Classification of Diseases, 9(th) Revision, Clinical Modification diagnosis codes 042.x-044.x. The effect of Elixhauser comorbidity measures on extending the LOS was assessed by comparing admissions in HIV patients with and without comorbidities using the Mann-Whitney U test. Multivariate logistic regression was performed to estimate the odds of having a decreased discharge.
  
  
  RESULTS
  A total of 57,027 hospital admissions were analyzed; 73% of patients were male, and the mean age was 39 years. The median LOS was 11 days, and the in-hospital mortality was 14%. The mean cost per hospitalization was 5,148.7€. A total of 83% of admissions were through the emergency room. During the period, inpatient HIV admissions decreased by 22%, LOS decreased by 9%, and in-hospital mortality dropped by 12%. Elixhauser comorbidities increased the median LOS in nearly all admissions.
  
  
  CONCLUSIONS
  Despite small regional variations, a strong, consistent decrease was observed in the hospital admission rate, mean cost, length of stay, and mortality rate for HIV-related admissions in Portugal during 2000-2010.
authors.affiliation: Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal. ecassoco@gmail.com.|Department of Pathology, Faculty of Medicine, Universidade Agostinho Neto, Luanda, Angola. ecassoco@gmail.com.|CINTESIS-Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal. ecassoco@gmail.com.|Departamento de Ciências da Informação e da Decisão em Saúde, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal. ecassoco@gmail.com.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Catumbela
authors.affiliation: Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal. alberto@med.up.pt.|CINTESIS-Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal. alberto@med.up.pt.
authors.forename: Alberto
authors.initials: A
authors.lastname: Freitas
authors.affiliation: Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal. fernando@med.up.pt.|CINTESIS-Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal. fernando@med.up.pt.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lopes
authors.affiliation: Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, USA. MendozaM@ao.cdc.gov.
authors.forename: Maria Del Carmen Torres
authors.initials: Mdel C
authors.lastname: Mendoza
authors.affiliation: National School of Public Health, University Nova de Lisbon, Lisbon, Portugal. ccosta@ensp.unl.pt.
authors.forename: Carlos
authors.initials: C
authors.lastname: Costa
authors.affiliation: Department of Infectious Diseases, Faculty of Medicine, University of Porto, Porto, Portugal. asarmento@med.up.pt.
authors.forename: António
authors.initials: A
authors.lastname: Sarmento
authors.affiliation: Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal. altamiro@med.up.pt.|CINTESIS-Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal. altamiro@med.up.pt.
authors.forename: Altamiro
authors.initials: A
authors.lastname: da Costa-Pereira
mesh_terms: D000328:Adult; D015897:Comorbidity; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D015658:HIV Infections / Q000191:economics*; D017721:Hospital Costs / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000191:economics* / Q000639:trends; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000639:trends*; D016015:Logistic Models; D008297:Male; D010351:Patient Discharge; D011174:Portugal