Hospital Readmissions Among Persons With Human Immunodeficiency Virus in the United States and Canada, 2005–2018: A Collaboration of Cohort Studies
Author:
Davy-Mendez Thibaut12ORCID, Napravnik Sonia12ORCID, Hogan Brenna C3, Eron Joseph J12, Gebo Kelly A34, Althoff Keri N34ORCID, Moore Richard D34, Silverberg Michael J5ORCID, Horberg Michael A6ORCID, Gill M John7, Rebeiro Peter F8, Karris Maile Y9, Klein Marina B10, Kitahata Mari M11ORCID, Crane Heidi M11, Nijhawan Ank12, McGinnis Kathleen A13, Thorne Jennifer E4, Lima Viviane D14, Bosch Ronald J15, Colasanti Jonathan A16, Rabkin Charles S17ORCID, Lang Raynell18, Berry Stephen A34, Benson Constance A, Bosch Ronald J, Kirk Gregory D, Greenberg Alan E, Castel Amanda D, Monroe Anne K, Marconi Vincent, Colasanti Jonathan, Mayer Kenneth H, Grasso Chris, Hogg Robert S, Lima Viviane D, Montaner Julio S G, Salters Kate, Buchacz Kate, Li Jun, Gebo Kelly A, Moore Richard D, Moore Richard D, Jacobson Jeffrey, Horberg Michael A, Silverberg Michael J, Thorne Jennifer E, Brown Todd, Tien Phyllis, D'Souza Gypsyamber, Smith Graham, Loutfy Mona, Gupta Meenakshi, Klein Marina B, Rabkin Charles, Kroch Abigail, Burchell Ann, Betts Adrian, Lindsay Joanne, Nijhawan Ank, Mayor Angel M, Gill M John, Martin Jeffrey N, Deeks Steven G, Li Jun, Brooks John T, Saag Michael S, Mugavero Michael J, Burkholder Greer, Bamford Laura, Karris Maile, Eron Joseph J, Napravnik Sonia, Kitahata Mari M, Crane Heidi M, Sterling Timothy R, Haas David, Rebeiro Peter, Turner Megan, McGinnis Kathleen, Justice Amy, Gange Stephen J, Lee Jennifer S, Hogan Brenna, Humes Elizabeth, Lang Raynell, Coburn Sally, Gerace Lucas, Stewart Cameron,
Affiliation:
1. School of Medicine 2. Gillings School of Global Public Health, University of North Carolina at Chapel Hill 3. Bloomberg School of Public Health 4. School of Medicine, Johns Hopkins University , Baltimore, Maryland 5. Division of Research, Kaiser Permanente Northern California , Oakland 6. Kaiser Permanente Mid-Atlantic Permanente Research Institute , Rockville, Maryland 7. Southern Alberta HIV Clinic , Calgary , Canada 8. School of Medicine, Vanderbilt University , Nashville, Tennessee 9. School of Medicine, University of California, San Diego 10. Faculty of Medicine, McGill University , Montreal, Quebec , Canada 11. School of Medicine, University of Washington , Seattle 12. Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas 13. Department of Internal Medicine, Veterans Affairs Connecticut Healthcare , West Haven 14. British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada 15. T. H. Chan School of Public Health, Harvard University , Boston, Massachusetts 16. School of Medicine, Emory University , Atlanta, Georgia 17. Division of Cancer Epidemiology and Genetics, National Cancer Institute , Bethesda, Maryland 18. Cumming School of Medicine, University of Calgary , Alberta , Canada
Abstract
Abstract
Background
Hospital readmission trends for persons with human immunodeficiency virus (PWH) in North America in the context of policy changes, improved antiretroviral therapy (ART), and aging are not well-known. We examined readmissions during 2005–2018 among adult PWH in NA-ACCORD.
Methods
Linear risk regression estimated calendar trends in 30-day readmissions, adjusted for demographics, CD4 count, AIDS history, virologic suppression (<400 copies/mL), and cohort.
Results
We examined 20 189 hospitalizations among 8823 PWH (73% cisgender men, 38% White, 38% Black). PWH hospitalized in 2018 versus 2005 had higher median age (54 vs 44 years), CD4 count (469 vs 274 cells/μL), and virologic suppression (83% vs 49%). Unadjusted 30-day readmissions decreased from 20.1% (95% confidence interval [CI], 17.9%–22.3%) in 2005 to 16.3% (95% CI, 14.1%–18.5%) in 2018. Absolute annual trends were −0.34% (95% CI, −.48% to −.19%) in unadjusted and −0.19% (95% CI, −.35% to −.02%) in adjusted analyses. By index hospitalization reason, there were significant adjusted decreases only for cardiovascular and psychiatric hospitalizations. Readmission reason was most frequently in the same diagnostic category as the index hospitalization.
Conclusions
Readmissions decreased over 2005–2018 but remained higher than the general population's. Significant decreases after adjusting for CD4 count and virologic suppression suggest that factors alongside improved ART contributed to lower readmissions. Efforts are needed to further prevent readmissions in PWH.
Funder
National Institutes of Health (NIH) Centers for Disease Control and Prevention
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Immunology and Allergy
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