Hospitalization Rates and Outcomes among Persons Living with HIV in the Southeastern United States, 1996-2016.

Abstract

BACKGROUND Advances in antiretroviral therapy, aging, and comorbidities impact hospitalization rates in HIV-infected populations. We examined temporal trends and patient characteristics associated with hospitalization rates and outcomes. METHODS Study population included patients in the University of North Carolina Center for AIDS Research HIV Clinical Cohort receiving clinical care 1996-2016. We estimated annual hospitalization rates, time to inpatient mortality or live discharge, and 30-day readmission risk using bivariable Poisson, Fine and Gray, and log-binomial regression models. RESULTS 4323 patients (29% women, 60% African-American) contributed 30 007 person-years. Overall, the hospitalization rate per 100 person-years was 34.3 (95% confidence interval [CI] 32.4, 36.4) with a mean change of -3% per year (95% CI -4%, -2%). Thirty-day readmission risk was 18.9% (95% CI 17.7%, 20.2%) and stable over time (P=0.21 and P=0.44 for 2010-2016 and 2003-2009, respectively, compared to 1996-2002). Patients who were Black (compared to White), older, had HIV RNA >400 copies/mL, or had CD4 count <200 cells/µL had higher hospitalization rates (all P<0.05). Higher inpatient mortality was associated with older age and lower CD4 (both P<0.05). Thirty-day readmission risk was higher among Black patients, those with detectable HIV RNA, and with lower CD4 cell counts (all P<0.05). CONCLUSIONS Hospitalization rates decreased from 1996 to 2016, but readmissions remained unchanged and high. Older patients, of minority race/ethnicity, and with uncontrolled HIV experienced higher rates and worse hospitalization outcomes. These findings underscore the importance of early diagnosis and treatment, linkage and retention in care, and care engagement at the time of hospital discharge.