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M9460647.TXT
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1994-06-25
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Document 0647
DOCN M9460647
TI Impact of immunosuppression on health care use by men in the Multicenter
AIDS Cohort Study (MACS).
DT 9408
AU Zucconi SL; Jacobson LP; Schrager LK; Kass NE; Lave JR; Carson CA;
Morgenstern H; Arno PS; Graham NM; Health Policy Institute, Graduate
School of Public Health,; University of Pittsburgh, PA 15261.
SO J Acquir Immune Defic Syndr. 1994 Jun;7(6):607-16. Unique Identifier :
AIDSLINE MED/94231466
AB The effects of human immunodeficiency virus type 1 (HIV-1) serostatus,
AIDS, and level of immunosuppression on health service use were examined
in the Multicenter AIDS Cohort Study. Data on self-reported
hospitalizations, outpatient medical services (non-emergency room) and
emergency room care during the preceding 6 months were collected for
3,447 homosexual/bisexual men returning for their 14th and/or 15th
semiannual visits in Chicago, Baltimore, Los Angeles, and Pittsburgh.
AIDS-free seropositive men with CD4+ cells < 200/microliters were more
likely to be hospitalized [odds ratio (OR) = 2.3, 95% confidence limits
(CL) = 1.4, 3.8] and use outpatient medical care (OR = 7.9, 95% CL =
4.9, 12.6), compared with seronegative men. Increased outpatient care
was initiated at the earliest stages of HIV-1 infection, even when CD4+
cells were > 500/microliter. Dramatic increases in outpatient care for
each level of immunosuppression were observed. HIV-1-related symptoms
were associated with increased hospitalizations (OR = 4.8, 95% CL = 3.2,
7.3), use of outpatient medical services (OR = 3.3, 95% CL = 1.9, 5.6),
and emergency room care (OR = 3.1, 95% CL = 2.1, 4.6). Persons with AIDS
and < or = 50 CD4+ cells/microliter most likely to be hospitalized (OR =
8.1; 95% CL = 4.4, 14.9). No significant difference (p > 0.05) in
emergency room use was observed according to HIV-1 serostatus, AIDS, or
immunosuppression, after adjusting for insurance and clinical symptoms.
To the extent that CD4+ cell counts are used as one of the criteria for
an AIDS diagnosis and such a diagnosis broadens available benefits to
persons with HIV disease, the pattern of health care services described
here will be important for health care providers and planners.
DE Acquired Immunodeficiency Syndrome/*ECONOMICS Adult Ambulatory
Care/UTILIZATION Bisexuality Cohort Studies Emergency Medical
Services/STATISTICS & NUMER DATA Health Services/*UTILIZATION
Homosexuality Hospitalization/STATISTICS & NUMER DATA Human HIV
Seropositivity/*ECONOMICS Income Insurance, Health Leukocyte Count
Male Middle Age Odds Ratio Prospective Studies Regression Analysis
Support, U.S. Gov't, P.H.S. T4 Lymphocytes United States JOURNAL
ARTICLE MULTICENTER STUDY
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).