Date of Award

Summer 2020

Document Type

Open Access Dissertation

Department

Health Services and Policy Management

First Advisor

Bankole A Olatosi

Abstract

Background:

Due to advances in Antiretroviral Therapy (ART), people living with HIV (PLWH) live longer in the United States. Aging prolongs exposure to HIV and antiretroviral drugs, which could lead to an elevated risk of developing multiple age-related comorbidities [HIV Associated Non-AIDS (HANA) conditions], earlier for PLWH. Higher comorbidity burdens among older PLWH may require greater use of inpatient care, i.e., higher hospitalization, inpatient resource utilization, and costs. This study examined the trends and characteristics of comorbidities, resource utilization, and costs of hospital stays with HIV (HSWH) compared to hospital stays without HIV (HSWOH). We also assessed trends for resource utilization and costs for hospital stays with major HANA conditions.

Methods:

Thirteen years of pooled data of Health Care Utilization Project (HCUP) National Inpatient Sample (NIS) data, 2003 through 2015, were analyzed to describe the trends. Among a total of 98,754,786 inpatient discharges, 69,633,686 inpatient discharges were analyzed. We excluded hospital stays for patients less than 18 years old, neonatal, pregnancy, and same-day discharge from our analysis. The primary outcomes of this study were the number of procedures, length of stay, and inpatient costs. Total hospital charges were converted to costs using hospital-wide cost-to-charge ratios provided by HCUP from accounting reports of the Center for Medicare and Medicaid Services. The key independent variables were age, and hospital stays with HIV. Using SAS 9.4, univariate, bivariate, and multivariable survey-weighted analyses were conducted using sampling weights to measure national estimates. Multivariable regression analyses using a generalized linear model (GLM) framework were conducted to determine predictors of inpatient resource utilization and costs, controlling for the patient- and hospital-level characteristics. The study results were interpreted using significance level at P

Results:

Over the study period, the proportions of HSWH remained stable (0.81%), but the proportions of HSWH among the older increased gradually. The mean age difference between HSWH and HSWOH reduced substantially. Hospitalization rates decreased from 105 to 89 per 100,000 U.S. population over the years, while the rates for the older population aged 55-64 and 65+ years increased substantially. Overall, HSWH had fewer HANA conditions than hospital stays without HIV (HSWOH). The proportions of cardiovascular disease (CVD) and cancer increased disproportionately over time among HSWH; CVD and liver disease increased among aged 65+ years, and CVD and cancer increased among aged 50-64 years.

The median number of procedures for HSWH was consistently lower than that for HSWOH, but it increased disproportionately among older HSWH over time. While the overall length of stay and costs for HSWH was consistently higher than that for HSWOH, the differences narrowed down over the study period. The differences in inpatient resource use and costs between HSWH and HSWOH also decreased for hospital stays with major HANA conditions. Multivariable analyses showed that the procedure use was lower for HSWH. Inpatient LOS and costs were significantly higher among HSWH and older.

Conclusions:

Consistent with the aging, higher HSWH and HANA comorbidities were observed among older PLWH during hospital stays, which suggest future increased hospital resource utilization and costs for HSWH. Our study finding confirms our hypothesis of increased length of stays and costs during HSWH and utilization of procedures among older HSWH. As PLWH age, a close investigation of surgical procedures and comorbidities requiring longer inpatient stays and higher costs is needed to prepare U.S. inpatient departments for future HSWH.

Available for download on Monday, August 15, 2022

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