National trends in hospitalization and mortality rates for patients with HIV, HCV, or HIV/HCV coinfection from 1996–2010 in the United States: a cross-sectional study

Abstract

BackgroundThe comparative impact of chronic viral monoinfection versus coinfection on inpatient outcomes and health care utilization is relatively unknown. This study examined trends, inpatient utilization, and hospital outcomes for patients with HIV, HCV, or HIV/HCV coinfection.MethodsData were from the 1996–2010 National Hospital Discharge Surveys. Hospitalizations with primary ICD-9-CM codes for HIV or HCV were included for HIV and HCV monoinfection, respectfully. Coinfection included both HIV and HCV codes. Demographic characteristics, select comorbidities, procedural interventions, average hospital length of stay (LOS), and discharge status were compared by infection status (HIV, HCV, HIV/HCV). Annual disease estimates and survey weights were used to generate hospitalization rates.Results~6.6 million hospitalizations occurred in patients with HIV (39%), HCV (56%), or HIV/HCV (5%). The hospitalization rate (hospitalizations per 100 persons with infection) decreased in the HIV group (29.8 in 1996; 5.3 in 2010), decreased in the HIV/HCV group (2.0 in 1996; 1.5 in 2010), yet increased in the HCV group (0.2 in 1996; 0.9 in 2010). Median LOS from 1996 to 2010 (days, interquartile range) decreased in all groups: HIV, 6 (3–10) to 4 (3–8); HCV, 5 (3–9) to 4 (2–6); HIV/HCV, 6 (4–11) to 4 (2–7). Age-adjusted mortality rates decreased for all three groups. The rate of decline was least pronounced for those with HCV monoinfection.ConclusionHospitalizations have declined more rapidly for patients with HIV infection (including HIV/HCV coinfection) than for patients with HCV infection. This growing disparity between HIV and HCV underscores the need to allocate more resources to HCV care in hopes that similar large-scale improvements can also be accomplished for patients with HCV.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-536) contains supplementary material, which is available to authorized users.

Hospitalizations Related to Hepatitis C Infection in Spain: Epidemiology and Comorbidities

“…Case-fatality rate in our study was 6.7% and was in line with previously published studies [15,22]. It increased with age and with the presence of comorbidities, being of great interest the increase in the risk of death in non-hepatic comorbidities also found in other studies [15,17,24].…”

“…In Spain, on the contrary, hospitalization rates shown in table 1 significantly decreased during the studied period. These figures could seem different to published data [15,17,22,23], but can in fact not directly be compared due to the different periods evaluated. In our study, hospitalization rates slightly decreased until 2010, sharply decreased in 2011, and slightly increased again since 2011.…”

“…Number of hospitalizations and hospitalization rates increased in the last years according to USA data from Nationwide Inpatient Sample [17,22] and Los Angeles County [23]. Another study performed in the USA evaluating national trends from 1996 to 2010 in hospitalizations for patients with HIV and HCV infection or coinfection in primary diagnostic position showed that hospitalizations in HCV monoinfected patients were declining less than in those with only HIV or both HIV/HCV infections, and concluded that more resources were needed for HCV monoinfection [15]. In Spain, on the contrary, hospitalization rates shown in table 1 significantly decreased during the studied period.…”

“…Despite the high prevalence of hepatitis C infection and the increase in associated hospitalizations, studies describing the incidence of hospitalizations related to hepatitis C infection and their hepatic and extrahepatic complications are scarce and refer to other countries [14][15][16][17]. The recent availability of new antiviral drugs against hepatitis C virus, with improved efficacy and better safety profiles, enable us to discern an important change in the current management of the disease.…”

Mortality, Hospitalization, and Quality of Life among Patients with Hepatitis C Infection on Hemodialysis

“…In the general population, HCV infection is associated with a 12-fold higher age-adjusted mortality rate (10). Between 1996 and 2010 there were .4 million hospitalizations at 500 hospitals in the United States among patients with HCV, and the rate increased during that period (11). HCV infection is also associated with inferior scores on quality of life testing (12,13).…”