Black race as a predictor of poor health outcomes among a national cohort of HIV/AIDS patients admitted to US hospitals: a cohort study

Abstract

BackgroundIn general, the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) population has begun to experience the benefits of highly active antiretroviral therapy (HAART); unfortunately, these benefits have not extended equally to Blacks in the United States, possibly due to differences in patient comorbidities and demographics. These differences include rates of hepatitis B and C infection, substance use, and socioeconomic status. To investigate the impact of these factors, we compared hospital mortality and length of stay (LOS) between Blacks and Whites with HIV/AIDS while adjusting for differences in these key characteristics.MethodsThe 1996–2006 National Hospital Discharge Surveys were used to identify HIV/AIDS patients admitted to US hospitals. Survey weights were incorporated to provide national estimates. Patients < 18 years of age, those who left against medical advice, those with an unknown discharge disposition and those with a LOS < 1 day were excluded. Patients were stratified into subgroups by race (Black or White). Two multivariable logistic regression models were constructed with race as the independent variable and outcomes (mortality and LOS > 10 days) as the dependent variables. Factors that were significantly different between Blacks and Whites at baseline via bivariable statistical tests were included as covariates.ResultsIn the general US population, there are approximately 5 times fewer Blacks than Whites. In the present study, 1.5 million HIV/AIDS hospital discharges were identified and Blacks were 6 times more likely to be hospitalized than Whites. Notably, Blacks had higher rates of substance use (30% vs. 24%; P < 0.001), opportunistic infections (27% vs. 26%; P < 0.001) and cocaine use (13% vs. 5%; P < 0.001). Conversely, fewer Blacks were co-infected with hepatitis C virus (8% vs. 12%; P < 0.001). Hepatitis B virus was relatively infrequent (3% for both groups). Crude mortality rates were similar for both cohorts (5%); however, a greater proportion of Blacks had a LOS > 10 days (21% vs. 19%; P < 0.001). Black race, in the presence of comorbidities, was correlated with a higher odds of LOS > 10 days (OR, 95% CI = 1.20 [1.10–1.30]), but was not significantly correlated with a higher odds of mortality (OR, 95% CI = 1.07 [0.93–1.25]).ConclusionBlack race is a predictor of LOS > 10 days, but not mortality, among HIV/AIDS patients admitted to US hospitals. It is possible that racial disparities in hospital outcomes may be closing with time.

Prevalence, trends, outcomes, and disparities in hospitalizations for nonalcoholic fatty liver disease in the United States

“…Hispanic culture treats elders with respect and views discharge to home as a more positive outcome [48]. Similarly to reports from other studies on blacks, we showed that they had a longer LOS and poorer discharge disposition, which might be related to their higher comorbidity burden [49,50]. On further analysis, our results showed that Blacks had the highest frequency of comorbidities (Deyo ≥1: 71.8%) vs. other races: Whites (68.34%), Hispanics (60.87%), and Asians and other races (65.4%).…”

The Effect of Peer-Driven Intervention on Rates of Screening for AIDS Clinical Trials Among African Americans and Hispanics

“…2 For example, from 1996 to 2006 African Americans with HIV/AIDS were 6 times more likely to be hospitalized for HIV/AIDS-related causes than wereWhites. 3,4 Further, in the period from 1987 to 2005, African American HIV mortality was 5 times higher than was that of Whites. 5,6 Moreover, these racial/ethnic disparities are increasing.…”

Half of 30-Day Hospital Readmissions Among HIV-Infected Patients Are Potentially Preventable

“…[4][5][6][7][8][9][10][11] With the introduction of highly active antiretroviral therapy (HAART) in 1996, overall rates of hospitalization among HIV-infected patients declined significantly, particularly for AIDS-related issues, 9 though subsequently admissions for other causes (liver disease, non-opportunistic infections) increased 1,2,4 and demonstrated ongoing health disparities for women, 1 patients with serious mental illness, 10 injection drug users 7,10 and African Americans. 1,5,8,11 In the HAART era, national HIV hospitalization costs were 3.2 billion in 2005, 12 and costs for readmissions in this population may be up to 32% higher than the index admission. 13 Readmission rates within 30 days of discharge are 19-25% for HIV-infected patients, 14,15 which is comparable to Medicare beneficiaries, 16,17 congestive heart failure (CHF) patients, 18,19 and higher than published readmission rates for acute myocardial infarction (MI,18.9%) 20 and pneumonia (17.4%).…”