Background
Hospitalization rates are an important clinical indicator to monitor treatment effectiveness and the complications of antiretroviral therapy and advanced HIV disease, and provide an endpoint for morbidity among people with HIV (PWH). We examined sociodemographic and clinical disparities in hospitalization rates among PWH in the HIV Outpatient Study (HOPS), a demographically diverse, multi-city cohort across the United States.
Methods
We analyzed medical records data from HOPS patients with ≥ 2 clinical encounters from 2008-2022. We assessed all-cause, HIV/AIDS-related, and non-HIV/AIDS-related hospitalization rates over time. Multivariable Poisson regression with generalized estimating equations examined sociodemographic and clinical differences in all-cause hospitalization rates.
Results
Of 5434 eligible patients, 2502 (46.0%) were non-Hispanic (NH) White, 1917 (35.3%) NH Black, and 802 (14.8%) Hispanic persons. Most were ≤50 years old (73.4%) at baseline (the later of either 1/1/2008 or the first HOPS visit), privately insured (51.4%), and men who have sex with men (MSM 59.1%). During a median follow-up of 5.5 years, 5261 hospitalizations occurred, with a rate of 14.8 per 100 person-year (PY), largely with non-HIV/AIDS-related causes (87.6%). The all-cause hospitalization rates (95% confidence interval) per 100 PY declined from 12.7 (11.0,14.7) in 2008 to 9.7 (8.2,11.4) in 2010, increased to 16.9 (14.6,19.5) in 2014 (peak), then slightly decreased to 13.9 (11.8,16.3) in 2018 and leveled off and measured 14.1 (11.3,17.4) in 2022. Non-HIV/AIDS related hospitalization rates showed a similar temporal pattern. Multivariable factors positively associated (P <0.05) with hospitalization included NH-Black and Hispanic race/ethnicity (vs. NH White), MSM (vs. heterosexual HIV risk group), public, self-pay, and other insurances (vs. private), higher HIV viral load and lower CD4 cell count prior to hospitalization, and certain comorbid conditions including cancer, liver and cardiovascular diseases; however, sex was not associated (Figure).
Conclusions
While hospitalization rates have declined for HOPS PWH in the past fifteen years, they continue to disproportionately affect persons who are Black, Hispanic, with more advanced HIV disease, and without private insurance. Addressing disparities by ensuring equitable access to services for the prevention and management of HIV disease and comorbidities can improve health outcomes for PWH.