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Racial/ethnic disparities remain in HIV-related hospitalizations, despite improved treatments

HIV-related admissions to community hospitals in seven States rose between 1993 and 1995, but the rates began a steady decline in late 1995 with the introduction of antiretroviral therapy for HIV infection. This decline occurred across all States, demographic groups, and insurers. However, the magnitude of the decline varied, with the greatest declines in hospitalization among white men and individuals with private insurance and the least decline among black men. The drop in HIV-related hospitalizations paralleled reported disparities in access to newly introduced antiretroviral therapies, which reduce viral load and increase CD4 cell counts.

Agency for Healthcare Research and Quality researchers John A. Fleishman, Ph.D., and Fred J. Hellinger, Ph.D., used hospital discharge data (1993-1997) to identify HIV-related hospital admissions and length of stay (LOS) at community hospitals in seven States: California, Colorado, Kansas, Maryland, New York, New Jersey, and South Carolina. Between early 1995 and late 1997, hospital admissions dropped 51 percent for white men, 37 percent for Hispanic men, and 32 percent for black men. During the same period, admissions dropped 40 percent for white women, 29 percent for Hispanic women, and 21 percent for black women.

Insurance also influenced HIV-hospitalization rates during this time. Admissions of privately insured patients (who were more likely to have access to new therapies) dropped 52 percent, and admissions of Medicaid patients dropped 38 percent; admissions of Medicare and self-pay patients also declined. Hospital LOS declined steadily from nearly 14 days per admission in 1993 to 9.5 days in 1997. Over all States and time periods, mean LOS was lowest for white men (10.01 days) and white women (10.88 days). LOS for Hispanics was 11.80 for men and 11.90 for women, whereas LOS for blacks was 12.72 for men and 12.04 for women. Mean LOS was higher for Medicaid admissions (12.30) than for private (10.78) or Medicare (10.85) admissions.

More details are in "Trends in HIV-related inpatient admissions from 1993 to 1997: A seven-state study," by Drs. Fleishman and Hellinger, in the September 2001 Journal of Acquired Immune Deficiency Syndromes 28(1), pp. 73-80.

Reprints (AHRQ Publication No. 02-R018) are available from the AHRQ Publications Clearinghouse.

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