Hospitalisation rates and associated factors in community-based cohorts of HIV-infected and -uninfected gay and bisexual men.
OBJECTIVE
There is evidence that HIV-positive patients are suffering from a greater burden of morbidity as they age due to nonAIDS-related complications. To date it has been difficult to determine what part of this excess risk is due to the health effects of HIV, its treatment or to lifestyle factors common to gay and bisexual men (GBM). We calculated overall and cause-specific hospitalisation rates and risk factors for hospitalisations in HIV-negative and HIV-positive cohorts of GBM and compare these with rates in the general male population.


METHODS
We conducted a record linkage study, linking two cohorts of HIV-negative (n = 1325) and HIV-positive (n = 557) GBM recruited in Sydney, New South Wales (NSW), Australia with the NSW hospital discharge data register. We compared rates of hospitalisation in the two cohorts and risk factors for hospitalisation using random-effects Poisson regression methods. Hospitalisation rates for each cohort were further compared with those in the general male population using indirect standardisation.


RESULTS
We observed 2032 hospitalisations in the HIV-negative cohort during 13,016 person-years (PYs) [crude rate: 15.6/100 PYs (95% CI: 14.9-16.3)] and 2130 hospitalisations in the HIV-positive cohort during 5571 PYs [crude rate: 38.2/100 PYs (95% CI: 36.6-39.9)]. HIV-positive individuals had an increased risk of hospitalisation compared with the HIV-negative individuals [adjusted-IRR: 2.34 (95% CI: 1.91-2.86)] and the general population [SHR: 1.45 (95% CI: 1.33-1.59)]. Hospitalisation rates were lower in the HIV-negative cohort compared with the general population [SHR: 0.72 (95% CI: 0.67-0.78)]. The primary causes of hospitalisation differed between groups.


CONCLUSIONS
HIV-positive GBM continue to experience excess morbidity compared with HIV-negative GBM men and the general population. HIV-negative GBM had lower morbidity compared with the general male population suggesting that GBM identity does not confer excess risk.
The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
C L
CL
Moore
The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
A E
AE
Grulich
The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.|Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia.
G
G
Prestage
School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
H F
HF
Gidding
The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
F
F
Jin
Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.
L
L
Mao
The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
K
K
Petoumenos
The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
I B
IB
Zablotska
The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
I M
IM
Poynten
The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
M G
MG
Law
The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
J
J
Amin
D000328:Adult; D001315:Australia / Q000453:epidemiology; D001727:Bisexuality / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015897:Comorbidity / Q000639:trends; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors
HIV; cohort studies; homosexuality; hospitalisation; medical record linkage