The Association Between Life Chaos, Health Care Use, and Health Status Among HIV-Infected Persons
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Whether having a stable and predictable lifestyle is associated with health care use and health status among HIV patients is unknown.
To develop and test the reliability and validity of a measure of life chaos for adults with HIV and examine its association with health care use and health status.
Prospective cohort study.
Two hundred twenty HIV-infected persons recruited from those who tested positive in a mobile testing van and from HIV clinics serving low-income populations.
Participants completed a survey every 6 months, assessing their health care use, SF-12 mental and physical health status and life chaos.
Cronbach’s alpha for the six-item measure of chaos was .67. Those without a spouse or partner and those with one or more unmet social service needs, such as housing or transportation, had higher chaos scores. Compared to those with less chaos, those with more chaos were less likely to have two or more outpatient visits (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI]: 0.24–0.98), more likely to have two or more missed visits (adjusted OR 2.30, 95%CI: 1.20–4.41) in the 6 months before study enrollment and had lower mental health status at enrollment and at follow-up. Life chaos was not associated with emergency department visits or physical health status.
We created a new measure of life chaos, which was associated with outpatient visits and mental health status. Chaos may be an important barrier to regular medical care. Future studies need to test this measure in more diverse populations and those with other diseases.
KEY WORDSHIV/AIDS health services research utilization health status
We attest that all authors meet the criteria for authorship and take responsibility for the scientific content of the manuscript.
Grant support: This project was supported by a grant from the Health Resources and Services Administration (H97HA00203). Dr. Wong received support from a Mentored Career Development Award from the National Institute on Aging (K08AG/HS21616-05) and a Faculty Development Award in Clinical Epidemiology from the Pfizer Foundation. Dr. Cunningham received support from a RCMAR grant from the National Institute on Aging (P30 AG021684) an EXPORT grant the National Center on Minority Health and Health Disparities (P20 MD000148) and a grant from the National Institute of Mental Health (R01 MH069087). Dr. Sarkisian was supported by a Paul B. Beeson Career Development Award in Aging from the National Institute on Aging (1K23AG024811).
Conflict of Interest
We have no conflicts of interest with respect to this study.
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