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AIDS and Behavior

, Volume 20, Issue 3, pp 555–564 | Cite as

Alcohol-Related Diagnoses and All-Cause Hospitalization Among HIV-Infected and Uninfected Patients: A Longitudinal Analysis of United States Veterans from 1997 to 2011

  • Christopher Rentsch
  • Janet P. Tate
  • Kathleen M. Akgün
  • Stephen Crystal
  • Karen H. Wang
  • S. Ryan Greysen
  • Emily A. Wang
  • Kendall J. Bryant
  • David A. Fiellin
  • Amy C. Justice
  • David Rimland
Original Paper

Abstract

Individuals with HIV infection are living substantially longer on antiretroviral therapy, but hospitalization rates continue to be relatively high. We do not know how overall or diagnosis-specific hospitalization rates compare between HIV-infected and uninfected individuals or what conditions may drive hospitalization trends. Hospitalization rates among United States Veterans were calculated and stratified by HIV serostatus and principal diagnosis disease category. Because alcohol-related diagnoses (ARD) appeared to have a disproportional effect, we further stratified our calculations by ARD history. A multivariable Cox proportional hazards model was fitted to assess the relative risk of hospitalization controlling for demographic and other comorbidity variables. From 1997 to 2011, 46,428 HIV-infected and 93,997 uninfected patients were followed for 1,497,536 person-years. Overall hospitalization rates decreased among HIV-infected and uninfected patients. However, cardiovascular and renal insufficiency admissions increased for all groups while gastrointestinal and liver, endocrine, neurologic, and non-AIDS cancer admissions increased among those with an alcohol-related diagnosis. After multivariable adjustment, HIV-infected individuals with an ARD had the highest risk of hospitalization (hazard ratio 3.24, 95 % CI 3.00, 3.49) compared to those free of HIV infection and without an ARD. Still, HIV alone also conferred increased risk (HR 2.08, 95 % CI 2.04, 2.13). While decreasing overall, risk of all-cause hospitalization remains higher among HIV-infected than uninfected individuals and is strongly influenced by the presence of an ARD.

Keywords

Inpatient care HIV Substance abuse Clinical epidemiology Aging 

Notes

Acknowledgments

This work was supported by the National Institutes of Health: AHRQ [R01-HS018372], NIAAA [U24-AA020794, U01-AA020790, U01-AA020795, U01-AA020799, U24-AA022001, U24 AA022007, U10 AA013566-completed], NHLBI [R01-HL095136; R01-HL090342], NIAID [U01-A1069918], NIMH [P30-MH062294], NIDA [R01DA035616], NCI [R01 CA173754] and the Veterans Health Administration Office of Research and Development [VA REA 08-266, VA IRR Merit Award, VISN 1 Career Development Award [V1CDA2012-20]] and Office of Academic Affiliations [Medical Informatics Fellowship]. This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, and Office of Research and Development. We must disclaim that the views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Supplementary material

10461_2015_1025_MOESM1_ESM.doc (39 kb)
Supplementary material 1 (DOC 39 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Christopher Rentsch
    • 1
    • 2
    • 3
  • Janet P. Tate
    • 2
    • 3
  • Kathleen M. Akgün
    • 2
    • 3
  • Stephen Crystal
    • 4
  • Karen H. Wang
    • 2
    • 3
  • S. Ryan Greysen
    • 5
  • Emily A. Wang
    • 3
  • Kendall J. Bryant
    • 6
  • David A. Fiellin
    • 3
  • Amy C. Justice
    • 2
    • 3
  • David Rimland
    • 1
    • 7
  1. 1.Infectious DiseasesAtlanta VA Medical CenterDecaturUSA
  2. 2.Research, VA Connecticut Healthcare SystemWest HavenUSA
  3. 3.School of MedicineYale UniversityNew HavenUSA
  4. 4.School of Social WorkRutgers UniversityNew BrunswickUSA
  5. 5.Division of Hospital MedicineUniversity of CaliforniaSan FranciscoUSA
  6. 6.National Institute on Alcohol Abuse and AlcoholismNational Institutes of HealthBethesdaUSA
  7. 7.School of MedicineEmory UniversityAtlantaUSA

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