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The Relationship of Age and Comorbid Conditions to Hospital and Nursing Home Days in HIV-Positive Versus Matched HIV-Negative Medicaid Recipients in United States
27 Pages Posted: 11 May 2023
More...Abstract
Background: Some studies of HIV and aging have compared how aging and comorbid conditions impact hospitalizations in persons with HIV (PWH) and persons without HIV (PWoH). However, nursing home days likely provide a better reflection of functional impairment and cumulative frailty than hospital days, and these have not been previously reported.
Methods: We studied Medicaid recipients, aged 18-64 years, residing in 14 U.S. states with the highest HIV prevalence from 2001 to 2012. We matched each of 270,312 PWH to four PWoH by baseline year, age, gender, and zip code. Outcomes were hospital and nursing home days per month (DPM). Comorbid condition groups were cardiovascular disease, diabetes, liver disease, mental health conditions, pulmonary disease, and renal disease. We used linear regression to examine the joint relationships of age and comorbid conditions on the two outcomes, stratified by sex at birth.
Findings: We found small excesses in the number of hospital DPM for PWH compared with PWoH. There were 0·03 and 0·07 extra hospital DPM for females and males, respectively, and no increases with age. In contrast, excess nursing home DPM for PWH compared with PWoH rose in a linear fashion with age, peaking at 0.35 extra days for females (age 55) and 0·4 extra days for males (age 60). HIV-associated excess nursing home DPM were greatest for persons with cardiovascular disease, diabetes, mental health conditions, and renal disease.
Interpretation: The HIV-associated pattern of excess nursing home DPM increases linearly from 30 to 55 (females) or 60 (males) years of age and may reflect an excess burden of frailty. Efforts to understand and interrupt this pattern are needed. Nursing home DPM may offer a new tool in understanding how HIV and comorbid conditions jointly impact aging with HIV.
Funding: This work was supported by 1R01MH102202-01A1 NIMH and R01MH109394-01A1 NIMH. Dr. Wilson is partially supported by the Providence/Boston Center for AIDS Research (P30AI042853) and by Institutional Development Award Number U54GM115677 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR) from the Rhode Island IDeA-CTR award (U54GM115677).
Declaration of Interest: There are no conflicts of interest.
Ethical Approval: This study was approved by the Brown University institutional review board, which waived the requirement for participant informed consent.
Keywords: HIV, aging, frailty, hospitals, nursing homes, health care utilization, Medicaid, United States
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