title: Patterns of Healthcare Utilization Among Veterans Infected With Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) and Coinfected With HIV/HCV: Unique Burdens of Disease.
abstract: Background.Hepatitis C virus (HCV) infection is a leading cause of cirrhosis and the primary cause of liver transplantation in the United States, and coinfection with human immunodeficiency virus (HIV) increases the risk of comorbidities. However, healthcare utilization (HCU) patterns among HIV/HCV-coinfected patients are poorly understood. This study compared the rates of HCU and reasons for hospital admission among HCV-infected, HIV-infected, and HIV/HCV-coinfected veterans.Methods.Hepatitis C virus- and HIV-infected and HIV/HCV-coinfected veterans in care with the Department of Veterans Affairs (VA) from 1998 to 2009 (n = 335 371, n = 28 179, n = 13 471, respectively) were identified by HIV- and HCV-associatedInternational Classification of Diseases, Ninth Revisioncodes from the clinical case registry. We assessed rates of HCU using emergency department (ED) visits, outpatient visits, and hospitalization and primary diagnoses associated with hospitalization. Independent risk factors associated with hospitalization were also examined.Results.Rates of outpatient and ED visits increased over the 11-year study period for all groups, with inpatient admission rates remaining stable. The HCU rates were consistently higher for the coinfected than other cohorts. The primary reason for hospital admission for all groups was psychiatric disease/substance use, accounting for 44% of all admissions. Nadir CD4 <350 cells/mm3was associated with higher rates of hospitalization versus nadir CD4 >500 cells/mm3.Conclusions.As the current population of HCV-infected, HIV-infected, and HIV/HCV-coinfected veterans age, they will continue to place a substantial and increasing demand on the US healthcare system, particularly in their utilization of ED and outpatient services. These data suggest the need for an ongoing investment in mental health and primary care within the VA healthcare system.
authors.affiliation: University of California , San Francisco.
authors.forename: Shereen
authors.initials: S
authors.lastname: Katrak
authors.affiliation: Duke University Medical Center, Durham; Durham Veterans Affairs Medical Center.
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Park
authors.affiliation: Duke University Medical Center, Durham; Durham Veterans Affairs Medical Center.
authors.forename: Christopher
authors.initials: C
authors.lastname: Woods
authors.affiliation: Duke University Medical Center, Durham; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Andrew
authors.initials: A
authors.lastname: Muir
authors.affiliation: University of California , San Diego.
authors.forename: Charles
authors.initials: C
authors.lastname: Hicks
authors.affiliation: Duke University Medical Center, Durham; Durham Veterans Affairs Medical Center; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Susanna
authors.initials: S
authors.lastname: Naggie
keywords: coinfection; healthcare utilization; hepatitis C virus; human immunodeficiency virus; veterans