Hospital Readmissions Among Persons With Human Immunodeficiency Virus in the United States and Canada, 2005-2018: A Collaboration of Cohort Studies

Thibaut Davy-Mendez; Sonia Napravnik; Brenna C Hogan; Joseph J Eron; Kelly A Gebo; Keri N Althoff; Richard D Moore; Michael J Silverberg; Michael A Horberg; M John Gill; Peter F Rebeiro; Maile Y Karris; Marina B Klein; Mari M Kitahata; Heidi M Crane; Ank Nijhawan; Kathleen A McGinnis; Jennifer E Thorne; Viviane D Lima; Ronald J Bosch; Jonathan A Colasanti; Charles S Rabkin; Raynell Lang; Stephen A Berry; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International epidemiology Databases to Evaluate AIDS (IeDEA)

doi:10.1093/infdis/jiad396

Hospital Readmissions Among Persons With Human Immunodeficiency Virus in the United States and Canada, 2005-2018: A Collaboration of Cohort Studies

J Infect Dis. 2023 Dec 20;228(12):1699-1708. doi: 10.1093/infdis/jiad396.

Authors

Thibaut Davy-Mendez^{1

2}, Sonia Napravnik^{1

2}, Brenna C Hogan³, Joseph J Eron^{1

2}, Kelly A Gebo^{3

4}, Keri N Althoff^{3

4}, Richard D Moore^{3

4}, Michael J Silverberg⁵, Michael A Horberg⁶, M John Gill⁷, Peter F Rebeiro⁸, Maile Y Karris⁹, Marina B Klein¹⁰, Mari M Kitahata¹¹, Heidi M Crane¹¹, Ank Nijhawan¹², Kathleen A McGinnis¹³, Jennifer E Thorne⁴, Viviane D Lima¹⁴, Ronald J Bosch¹⁵, Jonathan A Colasanti¹⁶, Charles S Rabkin¹⁷, Raynell Lang¹⁸, Stephen A Berry^{3

4}; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International epidemiology Databases to Evaluate AIDS (IeDEA)

Collaborators

North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International epidemiology Databases to Evaluate AIDS (IeDEA):
Constance A Benson, Ronald J Bosch, Gregory D Kirk, Alan E Greenberg, Amanda D Castel, Anne K Monroe, Vincent Marconi, Jonathan Colasanti, Kenneth H Mayer, Chris Grasso, Robert S Hogg, Viviane D Lima, Julio S G Montaner, Kate Salters, Kate Buchacz, Jun Li, Kelly A Gebo, Richard D Moore, Richard D Moore, Jeffrey Jacobson, Michael A Horberg, Michael J Silverberg, Jennifer E Thorne, Todd Brown, Phyllis Tien, Gypsyamber D'Souza, Graham Smith, Mona Loutfy, Meenakshi Gupta, Marina B Klein, Charles Rabkin, Abigail Kroch, Ann Burchell, Adrian Betts, Joanne Lindsay, Ank Nijhawan, Angel M Mayor, M John Gill, Jeffrey N Martin, Steven G Deeks, Jun Li, John T Brooks, Michael S Saag, Michael J Mugavero, Greer Burkholder, Laura Bamford, Maile Karris, Joseph J Eron, Sonia Napravnik, Mari M Kitahata, Heidi M Crane, Timothy R Sterling, David Haas, Peter Rebeiro, Megan Turner, Kathleen McGinnis, Amy Justice, Stephen J Gange, Jennifer S Lee, Brenna Hogan, Elizabeth Humes, Raynell Lang, Sally Coburn, Lucas Gerace, Cameron Stewart

Affiliations

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

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.

Keywords: HIV; aging; healthcare utilization; hospitalization; readmission.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Intramural
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adult
Canada / epidemiology
Cohort Studies
HIV
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Humans
Male
Patient Readmission*
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding