Abstract
BACKGROUND: Disparities in survival for black patients with HIV in the United States have been reported. The VA is an equal access health care system.
OBJECTIVE: To determine whether such disparities are present in the VA health care system.
DESIGN: Retrospective cohort study using national VA administrative databases.
PATIENTS: Two thousand three hundred and four white and 3,641 black HIV-infected patients first hospitalized for HIV between October 1, 1996 and September 30, 2000.
MEASUREMENTS: Thirty-day mortality after first hospitalization with HIV, and subsequent long-term survival. Follow-up ended at death or September 30, 2002. Data were adjusted for age, sex, HIV disease severity, non-HIV-related comorbidities, primary discharge diagnosis, hepatitis C status, and facility effects.
RESULTS: The mean follow-up was 3.2 years. Overall survival was similar for black patients compared with white patients (adjusted hazard ratio 1.09, P=.09). Hospital mortality was 7.0% for black and 6.4% for white patients (P=.35). Adjusted hospital mortality for black patients was similar to that of white patients (odds ratio 1.20, P=.10). Long-term survival after hospitalization did not significantly differ by race (adjusted hazard ratio 1.07, P=.21, for black patients compared with white patients).
CONCLUSIONS: Survival during and after first hospitalization with HIV in the VA did not significantly differ for white and black patients, possibly indicating similar effectiveness of care for HIV. Further research is needed to understand the reasons for the lack of disparities for VA patients with HIV and whether the VA’s results could be replicated.
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This work was supported by the National Institute of Mental Health, National Institutes of Health, grant K23MH067505 (T. P. G.), and the Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs, grant 02-293 (H. E. S.). The funding agencies had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript. T. P. G. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Financial Disclosures: This work was supported by the National Institute of Mental Health, National Institutes of Health, grant K23MH067505 (T. P. G.), and the Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs, grant 02-293 (H. E. S.).
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Giordano, T.P., Morgan, R.O., Kramer, J.R. et al. Is there a race-based disparity in the survival of veterans with HIV?. J Gen Intern Med 21, 613–617 (2006). https://doi.org/10.1111/j.1525-1497.2006.00452.x
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DOI: https://doi.org/10.1111/j.1525-1497.2006.00452.x