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Comorbidity Burden and Health Care Utilization by Substance use Disorder Patterns among People with HIV in Florida

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Abstract

Substance use disorder (SUD), a common comorbidity among people with HIV (PWH), adversely affects HIV clinical outcomes and HIV-related comorbidities. However, less is known about the incidence of different chronic conditions, changes in overall comorbidity burden, and health care utilization by SUD status and patterns among PWH in Florida, an area disproportionately affected by the HIV epidemic. We used electronic health records (EHR) from a large southeastern US consortium, the OneFlorida + clinical research data network. We identified a cohort of PWH with 3 + years of EHRs after the first visit with HIV diagnosis. International Classification of Diseases (ICD) codes were used to identify SUD and comorbidity conditions listed in the Charlson comorbidity index (CCI). A total of 42,271 PWH were included (mean age 44.5, 52% Black, 45% female). The prevalence SUD among PWH was 45.1%. Having a SUD diagnosis among PWH was associated with a higher incidence for most of the conditions listed on the CCI and faster increase in CCI score overtime (rate ratio = 1.45, 95%CI 1.42, 1.49). SUD in PWH was associated with a higher mean number of any care visits (21.7 vs. 14.8) and more frequent emergency department (ED, 3.5 vs. 2.0) and inpatient (8.5 vs. 24.5) visits compared to those without SUD. SUD among PWH was associated with a higher comorbidity burden and more frequent ED and inpatient visits than PWH without a diagnosis of SUD. The high SUD prevalence and comorbidity burden call for improved SUD screening, treatment, and integrated care among PWH.

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Acknowledgements

The OneFlorida Clinical Research Consortium was funded by the Patient-Centered Outcomes Research Institute number CDRN-1501-26692 and RI-CRN-2020-005; in part by the OneFlorida Cancer Control Alliance, funded by the Florida Department of Health’s James and Esther King Biomedical Research Program #4KB16. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology, the OneFlorida Clinical Research Consortium, the University of Florida’s Clinical and Translational Science Institute, the Florida Department of Health, or the National Institutes of Health.

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  1. Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0231, USA

    Yiyang Liu, Robert L. Cook & Mattia Prosperi

  2. Department of Medicine, Division of Infectious Diseases & Global Medicine, College of Medicine, University of Florida, Gainesville, FL, USA

    Preeti Manavalan

  3. Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA

    Khairul Siddiqi

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  1. Yiyang Liu
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Contributions

Liu Y - study design, data analysis, writing-original draft. Manavalan P - data interpretation, writing-original draft. Siddiqi K - data interpretation, writing-original draft. Cook RL - supervision, data interpretation, writing-editing. Prosperi M – study design, supervision, funding, writing-editing.

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Correspondence to Yiyang Liu.

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Funding

This work was supported by the National Institute of Allergy and Infectious Diseases (NIAID) under Award Number R01AI145552 (Co-PIs: Salemi, Prosperi) and National Institute on Alcohol Abuse and Alcoholism (NIAAA) U24 core Southern HIV and Alcohol Research Consortium (SHARC) grant – U24AA022002 (PI: Cook). Liu Y, Siddiqi K, Cook RL, and Prosperi M received research funding from the Merck Investigator Studies Program.

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Liu, Y., Manavalan, P., Siddiqi, K. et al. Comorbidity Burden and Health Care Utilization by Substance use Disorder Patterns among People with HIV in Florida. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04325-y

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