Patterns of hospital care for patients with HIV infection and AIDS.

OBJECTIVE--The aims were to describe the use of inpatient resources by patients with HIV infection and patients with AIDS; to examine trends in service use over time; and to provide data for planners concerned with service provision for HIV infection. SETTING--An inner London health district reporting 9% of AIDS cases nationally. DESIGN--Data on survival times and inpatient and day care use of resources were derived from existing patient records or collected prospectively between 1983 (when the first case of AIDS was diagnosed in the district) and 31 March 1990. SUBJECTS--A total of 488 HIV positive patients of whom 396 had been diagnosed as having AIDS were studied. MEASUREMENTS AND MAIN RESULTS--Inpatient days consumed per annum; trends in the number of bed days per person year with AIDS; the lifetime inpatient use per AIDS patient; and the influence of survival on service use estimates were determined. Altogether 16.4% of a total 17,785 hospital inpatient days were attributable to HIV positive patients who did not fulfil the criteria for AIDS. For patients with AIDS, there was an initial increase in the intensity of inpatient use in 1987 when a dedicated HIV ward was opened. After 1988, however, inpatient use fell to 30.8 bed days per person year with AIDS. Patients diagnosed after April 1987 had noticeably longer survival times than those diagnosed earlier (a median of 17-18 months compared with a median of 10-11 months). From 214 lifetime service use records, it was estimated that patients with short survival (less than six months) would consume 36 days of inpatient care, while those expected to survive longer would consume approximately twice that number of days, irrespective of how much longer they survived. CONCLUSIONS--The data indicate less intensive use of inpatient care by AIDS patients over time, and hence the apparent ability to manage an increasing AIDS patient workload without a comparable increase in occupied bed days. Increases in the size of that workload and changes in the survival profile of patients, together with a relatively constant rate of service demand by longer survivors, however, will continue to place increasing strains on finite inpatient resources. Further research is needed to establish the extent to which the greater use of outpatient and community services can offset this.     

Effect of changing patterns of care and duration of survival on the cost of treating the acquired immunodeficiency syndrome (AIDS).

We performed a two-year cost of illness study of 240 AIDS patients (55 percent of all Massachusetts cases) diagnosed and treated at five hospitals from March 1984 through February 1986. Sociodemographic and clinical data as well as information on medical utilization were obtained from review of inpatient and outpatient hospital records. The yearly inpatient cost per patient decreased by 28 percent from $38,369 in year one to $27,714 in year two. These changes were related to shorter lengths of stay (from 20.6 days to 16.8 days per hospitalization, mean difference of 3.8 days, 95% CI of the difference -.2, 7.8), and less costly hospitalizations (from $12,463 to $9,957, mean difference of $2,506, 95% CI of the difference $135, $4,877). The probability of hospitalization, however, was similar in both years. These patterns of care were still evident after controlling for transmission category, race, site, mortality, insurance, age, gender, number and type of opportunistic diseases and time since diagnosis. Although the cost per patient per year decreased between years one and two, median survival increased by 70 percent (from 10 to 17 months). Hence overall estimated lifetime costs increased by 24 percent.     

艾滋病病毒感染者和艾滋病患者卫生服务利用及医疗费用的研究

目的 了解艾滋病病毒(HIV)感染者和艾滋病(AIDS)患者对卫生服务的利用及直接医疗费用。方法 于1999年12月对北京佑安医院收治的HIV感染者和AIDS患者进行回顾性研究。收集一般人口学特征、HIV感染及疾病进程的相关信息、过去一年内卫生服务利用情况及医疗费用资料。结果 共调查29例HIV感染者，其中17例(58．62％)为无症状期的HIV感染者，12例为AIDS患者。无症状期的HIV感染者平均每人年门诊6次，住院1．23次，每人年住院58．6天；AIDS患者平均每人年门诊7．8次，住院2．1次，住院200．2天。无症状期的HIV感染者平均每人年门诊费用为13729元，住院费用为4745元；AIDS患者平均每人年门诊及住院费用分别为15053元和22242元。既门诊又住院平均每人年的门诊及住院医疗费用，无症状期的HIV感染者为16248元，AIDS患者为36795元。结论 HIV感染者和AIDS患者医疗费用昂贵，对卫生服务的需求量大。需要进一步在更大范围内了解国内HIV感染者和AIDS患者对卫生服务利用的现状及需求。     

Mental illness and length of inpatient stay for medicaid recipients with AIDS

OBJECTIVE: To examine the associations between comorbid mental illness and length of hospital stays (LOS) among Medicaid beneficiaries with AIDS. DATA SOURCE AND COLLECTION/STUDY SETTING: Merged 1992-1998 Medicaid claims and AIDS surveillance data obtained from the State of New Jersey for adults with >or=1 inpatient stay after an AIDS diagnosis from 1992 to 1996. STUDY DESIGN: Observational study of 6,247 AIDS patients with 24,975 inpatient visits. Severe mental illness (SMI) and other less severe mental illness (OMI) diagnoses at visits were ascertained from ICD-9 Codes. About 4 percent of visits had an SMI diagnosis; 5 percent had an OMI diagnosis; 43 percent did not have a mental illness diagnosis, but were patients who had been identified as having an SMI or OMI history; and 48 percent were from patients with no identified history of mental illness. PRINCIPAL FINDINGS: The overall mean hospital LOS was 12.7 days. After adjusting for measures of HIV disease severity and health care access in multivariate models, patients presenting with primary and secondary severe mental illness (SMI) diagnoses had approximately 32 percent and approximately 11 percent longer LOS, respectively, than did similar patients without a mental illness history (p<0.001 for each). But in these adjusted models of length of stay: (1) diagnosis of OMI was not related to LOS, and (2) in the absence of a mental illness diagnosed at the visit, an identified history of either SMI or OMI was also not related to LOS. In adjusted models of time to readmission for a new visit, current diagnosis of SMI or OMI and in the absences of a current diagnosis, history of SMI or OMI all tended to be associated with quicker readmission. CONCLUSIONS: This study finds greater (adjusted) LOS for AIDS patients diagnosed with severe mental illness (but not for those diagnosed with less severe mental comorbidity) at a visit. The effect of acute severe mental illness on hospitalization time may be comparable to that of an acute AIDS opportunistic illness. While previous research raises concerns that mental illness increases LOS by interfering with treatment of HIV conditions, the associations here may simply indicate that extra time is needed to treat severe mental illnesses or arrange for discharge of afflicted patients.     

Hospital charges for people with AIDS in Washington State: utilization of a statewide hospital discharge data base.

We analyzed Washington State inpatient hospital utilization for 165 AIDS (acquired immunodeficiency syndrome) cases with 344 hospitalizations from July 1984 through December 1985. We found that mean charges per hospitalization were $9,166 and mean length of stay was 13.3 days. In addition, evaluation of two diagnosis-related groups (DRGs 079 and 398) commonly used for AIDS hospitalizations showed that AIDS hospitalizations were substantially more expensive than non-AIDS hospitalizations within the same diagnosis-related group. AIDS-specific diagnosis-related groups may be necessary to achieve a balance between inpatient charges and reimbursements.     

Forecasting the personal medical care costs of AIDS from 1988 through 1991

The personal medical care costs of those diagnosed with acquired immunodeficiency syndrome (AIDS) in 1988 are forecast to be $2.2 billion, an amount that will increase to $4.5 billion in 1991. This is the first study to include the cost of purchasing azidothymidine (AZT), also called zidovudine, a palliative treatment for AIDS. The forecasts of this study are lower than those reported by Rice and Scitovsky, and other researchers, because the data are more recent and AIDS patients are receiving more care on an outpatient basis and staying in the hospital fewer days. They are also lower because projections for the number of AIDS cases diagnosed in future years are lower than those made by the Centers for Disease Control (CDC). This study projects that about 38,000 AIDS cases will be diagnosed in 1988 and 73,000 in 1991. The projections in this study are derived using data on the number of AIDS cases reported to CDC from January 1984 to October 1987, while the CDC projections employed by Rice and Scitovsky were derived using data from June 1981 to May 1986. It is also projected that the lifetime cost of treating an AIDS patient will increase from $57,000 in 1988 to $61,800 in 1991 due to the wider use of AZT.     

Hospital care for persons with AIDS in the European Union

This study estimates the current and future hospital resources for AIDS patients in the European Union (EU), using multinational scenario analysis (EU Concerted Action BMH1-CT-941723). In collaboration with another EU-project ('Managing the Costs of HIV Infection'), six national European studies on the utilization of hospital care for AIDS have been selected to provide the data for our analysis. The selection criteria involve recentness, quality, comparability, accessibility and representativeness. Baseline hospital resource utilization is estimated for hospital inpatient days and outpatient contracts, using a standardized approach controlling for two severity stages of AIDS (chronic stage and late stage). The epidemiological part of the study is based on standard models for backcalculating HIV incidence and projecting AIDS incidence, prevalence and mortality. In the next step, baseline resource utilization is linked to epidemiological information in a mixed prevalence and mortality-based approach. Several scenarios render different future epidemiological developments and hospital resource needs. For the year 1999, hospital bed needs of 10,000-12,700 in the EU are indicated, representing an increase of 20-60% compared to the estimated current (1995) level. The projected range for 1999 corresponds to a maximum of 0.65% of all hospital beds available in the EU. The growth in the number of outpatient hospital contacts is projected to possibly exceed that of inpatient days up to 1.82 million in 1999. Our methodology illustrates that estimation of current and future hospital care for AIDS has to be controlled for severity stages, to prevent biases. Further application of the multinational approach is demonstrated through a 'what-if' analysis of the potential impact of combination triple therapy for HIV/AIDS. Estimation of the economic impact of other diseases could as well benefit from the severity-stages approach.     

Survival with AIDS in Massachusetts, 1979 to 1989.

OBJECTIVES. The goal of the study was to determine survival time after diagnosis of acquired immunodeficiency syndrome (AIDS) and to identify predictors of survival. METHODS. We conducted a population-based prospective survival analysis of all Massachusetts-resident adult AIDS patients diagnosed from January 1, 1979, through December 31, 1988. RESULTS. Median survival was 406 days, with a 5-year survival rate of 3%. Age older than 40 years (P = .001), a diagnosis other than Kaposi's sarcoma (P = .001), and a history of intravenous drug use (P < or = .01) were associated with shorter survival after confounding was controlled. Survival increased as year of diagnosis became more recent (P < .0001). This temporal effect was strongest for patients with Pneumocystis carinii pneumonia. Individuals with Kaposi's sarcoma, Hispanics, homosexual men who were concurrent intravenous drug users, and residents of the greater Boston standard metropolitan statistical area, excluding the city of Boston, did not experience increases in survival over time. CONCLUSIONS. With the exception of cases initially defined by Kaposi's sarcoma, recently diagnosed AIDS case subjects survive longer than those diagnosed earlier in the epidemic. Further work is needed to determine whether this effect is due to lead-time bias or better treatment after diagnosis.     

Survival analysis of hemophilia-associated AIDS cases in the US.

Using national hemophilia-associated AIDS (acquired immunodeficiency syndrome) surveillance data and the life table method of survival analysis, the median length of survival of hemophilic patients in the United States after the diagnosis of AIDS was 11.7 months; the cumulative probability of survival at one year was 49.2 +/- 2.0 percent; at two years, 28.9 +/- 2.3 percent. Patients 13-29 years of age at the time of diagnosis had the longest survival and those 60 years and older had the shortest. Patients diagnosed since 1986 survived longer than those diagnosed before 1986. Length of survival did not differ significantly by race, coagulation disorder, AIDS manifestation at the time of diagnosis, or region of residence. Seven patients survived more than 36 months after AIDS was diagnosed. These patients were similar to those surviving for a shorter duration except that they were more likely to have met only the 1987 revision of the Centers for Disease Control AIDS surveillance case definition (as opposed to the 1985 case definition). Results of this study suggest that survival among hemophilic patients after the diagnosis of AIDS is similar to that reported by other investigators for other AIDS risk groups, excluding patients with Kaposi's sarcoma.     

Survival differences in Austrian patients with the acquired immunodeficiency syndrome

We investigated the association of clinical and demographic factors on survival of the 901 AIDS cases diagnosed until 31 December 1992 and reported to the Austrian Health Authorities up to 20 January 1994. The overall estimated median survival of patients with AIDS increased substantially from 8 months in 1987 to 16 months in 1988, although this increase was not significant by the log-rank test. However, the differences in hazard rates were larger at the beginning of the survival curve: between 1987 and 1988 the proportion surviving at 1 year increased from 41 to 62%, compared to an increase of the proportion surviving at 2 years from 30 to 35% (Breslow test,p value 0.008). AIDS patients diagnosed between 1988 and 1992 (n=755) were analyzed in more detail. Multivariate survival analysis revealed a shorter survival for those with residence in Eastern Austria, recipients of blood products, individuals with unknown transmission risk, those presenting with two AIDS indicator diseases and those with higher age at AIDS diagnosis. Candidal esophagitis as AIDS indicator disease was associated with longer survival. One hundred eighty-eight of the 755 AIDS patients (24.9%) died within the first 3 months after diagnosis of AIDS. We conclude that the survival time for AIDS patients has improved considerably after 1987, but survival is still very poor. Several factors have been shown to predict survival of patients with AIDS in Austria. Death within the first 3 months after the diagnosis of AIDS occurred at a relatively high frequency in Austrian AIDS patients. This may be caused by difficulties in the use of health care facilities or by the lack of awareness of HIV infection before diagnosis of AIDS either by patient or care provider.     

Dually eligible individuals with AIDS: characteristics and health services use

This paper explores the prevalence and health care utilization of dually eligible Medicare and Medicaid participants among New Jersey Medicaid recipients with AIDS using linked administrative data. Merged Medicaid claims and AIDS surveillance data were used to analyze participation in the Medicare program by Medicaid recipients in New Jersey diagnosed with AIDS who received services between January 1988 and March 1996. We found that nearly 30% of Medicaid participants had Medicare claims during the observation period, suggesting that Medicare is becoming an important payer of HIV care among individuals eligible for Medicaid. Traditionally disadvantaged groups such as women and racial minorities were less likely to be dually eligible for Medicare, reflecting differences in survival and in eligibility requirements for Social Security Disability Insurance (SSDI). Controlling for other characteristics, dually eligible individuals had shorter lengths of stay and had lower charges per inpatient stay than Medicaid only enrollees. Dual eligibles were also more likely to use antiretroviral (ARV) drugs and were more consistent users of ARV treatment measured by the proportion of time on ARV therapy. Our study suggests that persons with AIDS who may qualify for Medicare because of their disability are different than individuals who only received Medicaid reimbursed services in terms of their health care utilization. Further research is needed to determine the cause of such differences which may include socioeconomic differences between dual eligibles and Medicaid only eligibles, dissimilarities in health status between the two groups, and variation in aspects of insurance coverage particularly in the choice and reimbursement of office-based physicians.     

Updated forecasts of the costs of medical care for persons with AIDS, 1989-93

Data on the number of AIDS cases reported to the Centers for Disease Control (CDC) from January 1984 to June 1989 are used to predict the number of AIDS cases that will be diagnosed during the years 1989 through 1993. Using quadratic and linear models with the most recent data, it is projected that about 44,000 cases will be diagnosed in 1989, 56,000 in 1990, 70,000 in 1991, 87,000 in 1992, and 104,000 in 1993. These projections are lower than estimates derived using data from January 1984 to June 1988, and they are similar to estimates derived by the CDC. The lifetime medical care cost of treating a person with AIDS is estimated to be about $75,000 (all estimates are in 1988 dollars) assuming that the average length of survival is 15 months and that the intensity of care (that is, the cost of medical care per month) does not fall as longevity rises. This total, $75,000, reflects recent increases in the length of survival and the diffusion of costly drug therapies (for example, AZT and aerosol pentamidine). This study forecasts that the cumulative lifetime medical care costs of treating all people diagnosed with AIDS during a given year to be about $3.3 billion in 1989, $4.3 billion in 1990, $5.3 billion in 1991, $6.5 billion in 1992, and $7.8 billion in 1993.     

福建省HIV感染者/AIDS患者生存时间及影响因素分析

  目的  了解福建省1987 — 2018年艾滋病病毒感染者/艾滋病患者（HIV/AIDS）的生存情况及其影响因素,更好地为HIV/AIDS病例提供支持服务。  方法  采用回顾性病例对照研究方法,对福建省1987年1月 — 2018年12月累计报告的14 973例HIV/AIDS病例进行个案流行病学调查和定期随访,计算HIV/AIDS病例的全死因死亡率、生存时间和生存率,运用Cox比例风险模型和分类回归树模型分析HIV/AIDS病例生存情况的影响因素及不同参数变量对病例生存影响的重要性,并应用ROC曲线评价模型预测效果。  结果  截至2018年底,福建省14 973例HIV/AIDS病例中累计报告死亡病例2 537例,全死因死亡率为5.25/100人年,生存时间为210.3个月,5年生存率为80 %;Cox比例风险模型分析结果显示,报告当年疾病状态为AIDS的HIV/AIDS病例死亡风险较高,女性、年龄15～54岁、高中及以上文化程度、抗病毒治疗、最近1次CD₄⁺T淋巴细胞计数 ≥ 200个/mm³和样本来源为重点人群、羁押人群及其他人的HIV/AIDS病例死亡风险较低;分类回归树模型分析结果显示,抗病毒治疗是HIV/AIDS病例生存状况的首要影响因素,最近1次CD₄⁺T淋巴细胞计数、样本来源、诊断时年龄、文化程度和报告当年疾病状态的标准化重要性值依次分别为40.6、22.0、17.7、13.5和7.8,受试者工作特征曲线 (ROC）曲线下面积为0.762（95 % CI = 0.749～0.774）。  结论  福建省1987 — 2018年HIV/AIDS病例的生存状况持续保持在相对稳定水平,早期检测和抗病毒治疗等综合干预措施可以有助于改善病例的疾病进程,减少病例的死亡和延长生存时间。     

Migration to rural areas by HIV patients: impact on HIV-related healthcare use.

OBJECTIVE: To evaluate the impact of patient migration on human immunodeficiency virus (HIV)-related healthcare use in a rural setting. DESIGN: Data were collected on all patients seeking medical care related to HIV infection at The University of Iowa HIV/acquired immunodeficiency syndrome (AIDS) clinic. Information was collected related to patient care, stage of illness, prior and current residence, and clinic and hospital use. SETTING: An outpatient clinic in a university hospital offering primary and consultative medical care for persons with HIV infection. PATIENTS: All patients scheduled into clinic reported a previous positive HIV serologic test. RESULTS: Forty-five percent (81 of 181) of patients reported moving to Iowa, yet no more than 11% (n = 20) moved out of the state during the same period of observation. Of patients meeting the Centers for Disease Control criteria for AIDS, 24% were diagnosed prior to moving to Iowa (18 of 74). Twenty-seven percent of AIDS-related inpatient days of hospitalization and 19% of AIDS-related outpatient clinic visits were used by persons diagnosed in another state. Lifetime charges totalled for eight patients ranged from $24,873 to $232,556, with a mean of $109,934. CONCLUSIONS: A substantial portion of HIV-related healthcare in our rural area was used by individuals who had migrated to or back to Iowa. Further understanding of the reasons for and the extent of HIV patient migration to rural areas is needed.     

Identifying and interpreting subgroups in health care utilization data with count mixture regression models

Inpatient care is a large share of total health care spending, making analysis of inpatient utilization patterns an important part of understanding what drives health care spending growth. Common features of inpatient utilization measures such as length of stay and spending include zero inflation, overdispersion, and skewness, all of which complicate statistical modeling. Moreover, latent subgroups of patients may have distinct patterns of utilization and relationships between that utilization and observed covariates. In this work, we apply and compare likelihood-based and parametric Bayesian mixtures of negative binomial and zero-inflated negative binomial regression models. In a simulation, we find that the Bayesian approach finds the true number of mixture components more accurately than using information criteria to select among likelihood-based finite mixture models. When we apply the models to data on hospital lengths of stay for patients with lung cancer, we find distinct subgroups of patients with different means and variances of hospital days, health and treatment covariates, and relationships between covariates and length of stay.     

Annual All-Cause Healthcare Costs Among Influenza Patients With and Without Influenza-Related Complications

Background

Several studies have reported that patients with influenza have a high risk of developing complications such as secondary infections, exacerbation of cardiovascular conditions and asthma. However, limited data exists on the healthcare cost burden for influenza patients with and without influenza-related complications.

Objective

We compared healthcare utilization and costs among influenza patients with related complications versus patients without complications.

Methods

In this retrospective database analysis (LifeLink database: 1998–2009) of a US managed care database, we selected patients diagnosed with influenza during influenza seasons and categorized them as complicated or uncomplicated based on the presence or absence of a diagnosis for a related complication in the year following their influenza diagnosis. Multivariable regression analyses were conducted to compare all-cause utilization and costs (adjusted to 2009 US dollars) between the two groups.

Results

We identified 54,469 patients of which ~65 % had evidence for at least one complication. Patients with complicated influenza had a 1.5-fold higher rate of inpatient utilization compared with uncomplicated cases (p < 0.001). Significantly higher covariate-adjusted predicted mean annual costs were also observed among complicated influenza patients across all care (p-values <0.001 for all comparisons).

Conclusion

Healthcare costs were twice as high among influenza patients with complications versus those without, with inpatient and outpatient services being the primary cost drivers. Now with the universal recommendation for seasonal influenza vaccination for all individuals ≥6 months of age, improvement in coverage rates may help reduce the healthcare utilization and costs associated with influenza and associated complications.     

One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims

OBJECTIVE: This study examined rates and cost of inpatient and outpatient treatment among 1,932 patients with an eating disorder. METHOD: One-year (1995) data were available through MarketScan, a national insurance database containing claims for 1,902,041 male patients and 2,005,760 female patients. RESULTS: Female patients (n = 1,756, 0.14% of all females) were significantly more likely to have been treated for an eating disorder than male patients (n = 176, 0.016% of all males), and females received more days of treatment than males. Outpatient treatment was the norm, regardless of gender or type of eating disorder. Average number of days (inpatient or outpatient) was less than the minimum recommended by standards of care. Age-adjusted costs for the treatment of anorexia nervosa and bulimia nervosa were comparable to the cost of treatment for schizophrenia. DISCUSSION: The utilization data are discussed in terms of barriers to care and treatment guidelines for eating disorders.     

Hospital care for p ersons with AIDS in European‐Union countries; a cross‐country comparison

This paper compares AIDS hospital care in several European‐Union countries. For this purpose hospital‐care utilisation studies on inpatient days and outpatient contacts were analysed in a generic approach controlling for severity stages of AIDS. Lifetime hospital‐care needs for AIDS are derived, providing useful information for health‐care policy makers. In a next step, lifetime estimates are linked to estimated annual new cases of AIDS, resulting from standardised epidemiological modelling. These results on AIDS impact at the population level are reported including statistical confidence limits. Both lifetime hospital‐care needs at the patient level and AIDS impact at the population level are compared between countries and related to characteristics of the national AIDS epidemics and health‐care systems. A person with AIDS has a contact – either inpatient day or outpatient visit – with the hospital in 14% (UK) to 24% (France) of the days spent in the AIDS stage. Related to the national AIDS epidemics (epidemiological impact), Italy and Greece have high levels of outpatient contacts per million population. Estimated hospital‐bed needs for AIDS in 1995 are up to 2.13% (in Spain) of total national acute‐care hospital beds available. Estimated per‐capita needs for outpatient visits in 1995 are highest in Italy, corresponding to 108 doctor full‐time equivalents. In a case‐study for Greece and The Netherlands, differences in hospital‐care utilisation patterns were assessed to correspond with differences in their health‐care systems (number of hospital beds, doctors and nurses per capita and some qualitative characteristics of medical care in both countries). International comparison of AIDS hospital care is possible using standardised analysis of national hospital‐care utilisation data and standardised epidemiological modelling. Estimates of lifetime hospital‐care needs are an essential input for cost‐effectiveness analyses used to aid health‐care policy decision‐making. This revised version was published online in July 2006 with corrections to the Cover Date.     

常德市性传播艾滋病病毒感染者/艾滋病患者生存状况及影响因素分析

目的 分析常德市经性传播艾滋病病毒感染者(HIV)/艾滋病患者(AIDS)生存状况及影响因素。方法 利用中国疾病预防控制信息系统艾滋病综合防治信息系统,收集2000年1月1日-2016年12月31日经性传播的2 300例HIV/AIDS患者的发病、死亡等信息及影响因素,采用回顾性队列研究分析他们的生存时间及其影响因素。结果 2 300例研究对象平均生存时间为(129.97±3.319)个月,1、5、10、16年累积生存率分别为75.4%、60.0%、48.1%、48.1%。单因素分析显示,患者确诊时的年龄、婚姻状况、文化程度、感染途径和接受艾滋病抗病毒治疗情况是性传播HIV/AIDS生存时间的影响因素(均P＜0.05)。多因素分析显示,确诊HIV抗体阳性时的年龄＞49岁死亡风险高于年龄17～24岁组(HR=2.774,95%CI:1.768～4.353, P=0.000);异性传播病例的死亡风险大于同性传播病例(HR=3.065,95%CI:1.972～4.763, P=0.000);未接受艾滋病抗病毒治疗组的死亡风险高于治疗组(HR=7.414,95%CI:6.193～8.876, P=0.000)。 结论 常德市经性传播HIV/AIDS患者的生存状况一般。年龄、传播途径、治疗接受艾滋病抗病毒治疗是影响生存时间的重要因素。＞49岁和异性传播HIV/AIDS患者死亡风险更高,接受抗病毒治疗可减少AIDS的死亡并延长生存时间。     

The effect of extension of benefit coverage for cancer patients on health care utilization across different income groups in South Korea

To provide financial protection against catastrophic illness, the Korean government expanded the National Health Insurance (NHI) benefit coverage for cancer patients in 2005. This paper examined whether the policy improved the income-related equality in health care utilization. This study analyzed the extent to which the policy improved income-related equality in outpatient visits, inpatient days, and inpatient and outpatient care expenditure based on triple difference estimator. Using nationwide claims data of the NHI from 2002 to 2004 and from 2006 to 2010, we compared cancer patients as a treatment group with liver disease as a control group and low-income group with the highest-income group. The results showed that the extension of NHI benefits coverage led to an increase in the utilization of outpatient services across all income groups, but with a greater increase for the low-income groups, among cancer patients. Moreover, the policy led to a less decrease in the utilization of inpatient services for the low-income group while it decreased across all income groups. Our finding suggests that the extension of NHI benefits coverage improved the income-related equality in health care utilization.