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. 1999 Feb;33(6):1611–1638.

Incidence and duration of hospitalizations among persons with AIDS: an event history approach.

S Crystal 1, A T Lo Sasso 1, U Sambamoorthi 1
PMCID: PMC1070339  PMID: 10029500

Abstract

OBJECTIVE: To analyze hospitalization patterns of persons with AIDS (PWAs) in a multi-state/multi-episode continuous time duration framework. DATA SOURCES: PWAs on Medicaid identified through a match between the state's AIDS Registry and Medicaid eligibility files; hospital admission and discharge dates identified through Medicaid claims. STUDY DESIGN: Using a Weibull event history framework, we model the hazard of transition between hospitalized and community spells, incorporating the competing risk of death in each of these states. Simulations are used to translate these parameters into readily interpretable estimates of length of stay, the probability that a hospitalization will end in death, and the probability that a nonhospitalized person will be hospitalized within 90 days. PRINCIPAL FINDINGS: In multivariate analyses, participation in a Medicaid waiver program offering case management and home care was associated with hospital stays 1.3 days shorter than for nonparticipants. African American race and Hispanic ethnicity were associated with hospital stays 1.2 days and 1.0 day longer than for non-Hispanic whites; African Americans also experienced more frequent hospital admissions. Residents of the high-HIV-prevalence area of the state had more frequent admissions and stays two days longer than those residing elsewhere in the state. Older PWAs experienced less frequent hospital admissions but longer stays, with hospitalizations of 55-year-olds lasting 8.25 days longer than those of 25-year-olds. CONCLUSIONS: Much socioeconomic and geographic variability exists both in the incidence and in the duration of hospitalization among persons with AIDS in New Jersey. Event history analysis provides a useful statistical framework for analysis of these variations, deals appropriately with data in which duration of observation varies from individual to individual, and permits the competing risk of death to be incorporated into the model. Transition models of this type have broad applicability in modeling the risk and duration of hospitalization in chronic illnesses.

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Selected References

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  1. Andrulis D. P., McGregor C. M., Weiss K. B., Ramirez K. L., Ginsberg C. A., Shaw-Taylor Y. U.S. hospital care for HIV-infected persons and the role of public and private teaching hospitals: 1988-1991. J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Jun 1;9(2):193–203. [PubMed] [Google Scholar]
  2. Andrulis D. P., Weslowski V. B., Hintz E., Spolarich A. W. Comparisons of hospital care for patients with AIDS and other HIV-related conditions. JAMA. 1992 May 13;267(18):2482–2486. [PubMed] [Google Scholar]
  3. Bennett C. L., Adams J., Bennett R. L., Rodrique D., George L., Cassileth B., Gilman S. C. The learning curve for AIDS-related Pneumocystis carinii pneumonia: experience from 3,981 cases in Veterans Affairs Hospitals 1987-1991. J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Apr 1;8(4):373–378. [PubMed] [Google Scholar]
  4. Cherubin C. E., Sapira J. D. The medical complications of drug addiction and the medical assessment of the intravenous drug user: 25 years later. Ann Intern Med. 1993 Nov 15;119(10):1017–1028. doi: 10.7326/0003-4819-119-10-199311150-00009. [DOI] [PubMed] [Google Scholar]
  5. Cohn S. E., Klein J. D., Weinstein R. A., Shapiro M. F., DeHovitz J. A., Kessler H. A., Dickinson G. M., Rodrigue D. C., Bennett C. L. Geographic variation in the management and outcome of patients with AIDS-related Pneumocystis carinii pneumonia. J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Dec 15;13(5):408–415. doi: 10.1097/00042560-199612150-00002. [DOI] [PubMed] [Google Scholar]
  6. Cunningham W. E., Mosen D. M., Hays R. D., Andersen R. M., Shapiro M. F. Access to community-based medical services and number of hospitalizations among patients with HIV disease: are they related? J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Dec 1;13(4):327–335. doi: 10.1097/00042560-199612010-00005. [DOI] [PubMed] [Google Scholar]
  7. Ettner S. L., Weissman J. Utilization of formal and informal home care by AIDS patients in Boston: a comparison of intravenous drug users and homosexual males. Med Care. 1994 May;32(5):459–470. doi: 10.1097/00005650-199405000-00005. [DOI] [PubMed] [Google Scholar]
  8. Fleishman J. A., Hsia D. C., Hellinger F. J. Correlates of medical service utilization among people with HIV infection. Health Serv Res. 1994 Dec;29(5):527–548. [PMC free article] [PubMed] [Google Scholar]
  9. Fleishmann J. A., Mor V., Laliberte L. L. Longitudinal patterns of medical service use and costs among people with AIDS. Health Serv Res. 1995 Aug;30(3):403–424. [PMC free article] [PubMed] [Google Scholar]
  10. Green J., Arno P. S. The 'Medicaidization' of AIDS. Trends in the financing of HIV-related medical care. JAMA. 1990 Sep 12;264(10):1261–1266. doi: 10.1001/jama.264.10.1261. [DOI] [PubMed] [Google Scholar]
  11. Hellinger F. J. The use of health services by women with HIV infection. Health Serv Res. 1993 Dec;28(5):543–561. [PMC free article] [PubMed] [Google Scholar]
  12. Horner R. D., Bennett C. L., Achenbach C., Rodriguez D., Adams J., Gilman S. C., Cohn S. E., Dickinson G. M., DeHovitz J. A., Weinstein R. A. Predictors of resource utilization for hospitalized patients with Pneumocystis carinii pneumonia (PCP): a summary of effects from the multi-city study of quality of PCP care. J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Aug 1;12(4):379–385. doi: 10.1097/00042560-199608010-00008. [DOI] [PubMed] [Google Scholar]
  13. Kelly J. V., Ball J. K., Turner B. J. Duration and costs of AIDS hospitalizations in New York. Variations by patient severity of illness and hospital type. Med Care. 1989 Dec;27(12):1085–1098. doi: 10.1097/00005650-198912000-00001. [DOI] [PubMed] [Google Scholar]
  14. Liu K., Coughlin T., McBride T. Predicting nursing-home admission and length of stay. A duration analysis. Med Care. 1991 Feb;29(2):125–141. doi: 10.1097/00005650-199102000-00005. [DOI] [PubMed] [Google Scholar]
  15. Markson L. E., McKee L., Mauskopf J., Houchens R., Fanning T. R., Turner B. J. Patterns of Medicaid expenditures after AIDS diagnosis. Health Care Financ Rev. 1994 Summer;15(4):43–59. [PMC free article] [PubMed] [Google Scholar]
  16. Merzel C., Crystal S., Sambamoorthi U., Karus D., Kurland C. New Jersey's Medicaid waiver for acquired immunodeficiency syndrome. Health Care Financ Rev. 1992 Spring;13(3):27–44. [PMC free article] [PubMed] [Google Scholar]
  17. Minkoff H. L., DeHovitz J. A. Care of women infected with the human immunodeficiency virus. JAMA. 1991 Oct 23;266(16):2253–2258. [PubMed] [Google Scholar]
  18. Moore R. D., Hidalgo J., Sugland B. W., Chaisson R. E. Zidovudine and the natural history of the acquired immunodeficiency syndrome. N Engl J Med. 1991 May 16;324(20):1412–1416. doi: 10.1056/NEJM199105163242006. [DOI] [PubMed] [Google Scholar]
  19. Mor V., Fleishman J. A., Dresser M., Piette J. Variation in health service use among HIV-infected patients. Med Care. 1992 Jan;30(1):17–29. doi: 10.1097/00005650-199201000-00002. [DOI] [PubMed] [Google Scholar]
  20. Mouton Y., Alfandari S., Valette M., Cartier F., Dellamonica P., Humbert G., Lang J. M., Massip P., Mechali D., Leclercq P. Impact of protease inhibitors on AIDS-defining events and hospitalizations in 10 French AIDS reference centres. Fédération National des Centres de Lutte contre le SIDA. AIDS. 1997 Oct;11(12):F101–F105. doi: 10.1097/00002030-199712000-00003. [DOI] [PubMed] [Google Scholar]
  21. Palella F. J., Jr, Delaney K. M., Moorman A. C., Loveless M. O., Fuhrer J., Satten G. A., Aschman D. J., Holmberg S. D. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998 Mar 26;338(13):853–860. doi: 10.1056/NEJM199803263381301. [DOI] [PubMed] [Google Scholar]
  22. Piette J. D., Mor V., Mayer K., Zierler S., Wachtel T. The effects of immune status and race on health service use among people with HIV disease. Am J Public Health. 1993 Apr;83(4):510–514. doi: 10.2105/ajph.83.4.510. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Piette J., Stein M., Mor V., Fleishman J., Mayer K., Wachtel T., Carpenter C. Patterns of secondary prophylaxis with aerosol pentamidine among persons with AIDS. J Acquir Immune Defic Syndr. 1991;4(8):826–828. [PubMed] [Google Scholar]
  24. Rosenblum L., Buehler J. W., Morgan M. W., Costa S., Hidalgo J., Holmes R., Lieb L., Shields A., Whyte B. HIV infection in hospitalized patients and Medicaid enrollees: the accuracy of medical record coding. Am J Public Health. 1993 Oct;83(10):1457–1459. doi: 10.2105/ajph.83.10.1457. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Seage G. R., 3rd, Hertz T., Stone V. E., Epstein A. M. The effects of intravenous drug use and gender on the cost of hospitalization for patients with AIDS. J Acquir Immune Defic Syndr. 1993 Jul;6(7):831–839. [PubMed] [Google Scholar]
  26. Solomon L., Stein M., Flynn C., Schuman P., Schoenbaum E., Moore J., Holmberg S., Graham N. M. Health services use by urban women with or at risk for HIV-1 infection: the HIV Epidemiology Research Study (HERS). J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Mar 1;17(3):253–261. doi: 10.1097/00042560-199803010-00011. [DOI] [PubMed] [Google Scholar]
  27. Sowell R. L., Gueldner S. H., Killeen M. R., Lowenstein A., Fuszard B., Swansburg R. Impact of case management on hospital charges of PWAs in Georgia. J Assoc Nurses AIDS Care. 1992 Apr-Jun;3(2):24–31. [PubMed] [Google Scholar]
  28. Stone V. E., Seage G. R., 3rd, Hertz T., Epstein A. M. The relation between hospital experience and mortality for patients with AIDS. JAMA. 1992 Nov 18;268(19):2655–2661. [PubMed] [Google Scholar]
  29. Torres R. A., Barr M. Impact of combination therapy for HIV infection on inpatient census. N Engl J Med. 1997 May 22;336(21):1531–1532. doi: 10.1056/nejm199705223362118. [DOI] [PubMed] [Google Scholar]
  30. Turner B. J., Kelly J. V., Ball J. K. A severity classification system for AIDS hospitalizations. Med Care. 1989 Apr;27(4):423–437. doi: 10.1097/00005650-198904000-00009. [DOI] [PubMed] [Google Scholar]
  31. Turner B. J., McKee L., Fanning T., Markson L. E. AIDS specialist versus generalist ambulatory care for advanced HIV infection and impact on hospital use. Med Care. 1994 Sep;32(9):902–916. doi: 10.1097/00005650-199409000-00002. [DOI] [PubMed] [Google Scholar]
  32. Weissman G., Melchior L., Huba G., Altice F., Booth R., Cottler L., Genser S., Jones A., McCarthy S., Needle R. Women living with substance abuse and HIV disease: medical care access issues. J Am Med Womens Assoc. 1995 May-Aug;50(3-4):115–120. [PubMed] [Google Scholar]
  33. Weissman J. S., Cleary P. D., Seage G. R., 3rd, Gatsonis C., Haas J. S., Chasan-Taber S., Epstein A. M. The influence of health-related quality of life and social characteristics on hospital use by patients with AIDS in the Boston Health Study. Med Care. 1996 Oct;34(10):1037–1056. doi: 10.1097/00005650-199610000-00005. [DOI] [PubMed] [Google Scholar]
  34. Williams R., Zyzanski S. J., Wright A. L. Life events and daily hassles and uplifts as predictors of hospitalization and outpatient visitation. Soc Sci Med. 1992 Apr;34(7):763–768. doi: 10.1016/0277-9536(92)90363-u. [DOI] [PubMed] [Google Scholar]

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