TY - JOUR
T1 - Insurance status and mortality among patients with AIDS
AU - the Studies of the Ocular Complications of AIDS Research Group
AU - Jabs, A. W.
AU - Jabs, D. A.
AU - Van Natta, M. L.
AU - Palella, F. J.
AU - Meinert, C. L.
N1 - Funding Information:
Conflicts of interest: AWJ, DAJ, MLVN and CLM have no conflicts of interest to declare. FJP has been a consultant and/or on the speakers’ bureau for Gilead Sciences, Janssen Pharmaceutical, Merck and Co, and Bristol Myers Squibb. Financial disclosure: This work was supported by cooperative agreements provided by the National Eye Institute, the National Institutes of Health, Bethesda, MD to the Icahn School of Medicine at Mount Sinai, New York, NY (U10 EY 08052); The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (U10 EY 08057); and the University of Wisconsin, Madison School of Medicine and Public Health, Madison, WI (U10 EY 08067).
Funding Information:
Financial disclosure: This work was supported by cooperative agreements provided by the National Eye Institute, the National Institutes of Health, Bethesda, MD to the Icahn School of Medicine at Mount Sinai, New York, NY (U10 EY 08052); The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (U10 EY 08057); and the University of Wisconsin, Madison School of Medicine and Public Health, Madison, WI (U10 EY 08067).
Publisher Copyright:
© 2017 British HIV Association
PY - 2018/1
Y1 - 2018/1
N2 - Objectives: The aim of the study was to evaluate risk factors for mortality, including health care insurance status, among patients with AIDS in the era of modern combination antiretroviral therapy (cART). Methods: This study was part of the prospective, multicentre, observational Longitudinal Study of the Ocular Complications of AIDS (LSOCA). Patients were classified as having private health care insurance, Medicare, Medicaid, or no insurance. Hazard ratios (HRs) for death were calculated using proportional hazards regression models and staggered entries, anchored to the AIDS diagnosis date. Results: Among 2363 participants with AIDS, 97% were treated with cART. At enrolment, 31% of participants had private insurance, 29% had Medicare, 24% had Medicaid, and 16% were uninsured. Noninfectious, age-related diseases, such as hypertension, diabetes, and renal disease, were more frequent among persons with Medicare than among those with private insurance. Compared with those who were privately insured, mortality was greater among participants with Medicare [adjusted HR (HRadj) 1.35; 95% confidence interval (CI) 1.08–1.67; P = 0.008]. Among participants with a suppressed HIV viral load, compared with those who were privately insured, HRadj values for mortality were 1.93 (95% CI 1.08–3.44; P = 0.02) for those with Medicare and 2.09 (95% CI 1.02–4.27; P = 0.04) for those with Medicaid. Mortality among initially uninsured participants was not significantly different from that for privately insured participants, but these participants typically obtained ART and insurance during follow-up. Compared with privately insured participants, time-updated HRadj values for mortality were 1.34 (95% CI 1.05–1.70; P = 0.02) for those with Medicare, 1.34 (95% CI 1.01–1.80; P = 0.05) for those with Medicaid, and 1.35 (95% CI 0.97–1.88; P = 0.05) for those who were uninsured. Conclusions: In persons with AIDS, compared with those with private insurance, those with public insurance had increased mortality, possibly as a result of a greater burden of noninfectious, age-related diseases.
AB - Objectives: The aim of the study was to evaluate risk factors for mortality, including health care insurance status, among patients with AIDS in the era of modern combination antiretroviral therapy (cART). Methods: This study was part of the prospective, multicentre, observational Longitudinal Study of the Ocular Complications of AIDS (LSOCA). Patients were classified as having private health care insurance, Medicare, Medicaid, or no insurance. Hazard ratios (HRs) for death were calculated using proportional hazards regression models and staggered entries, anchored to the AIDS diagnosis date. Results: Among 2363 participants with AIDS, 97% were treated with cART. At enrolment, 31% of participants had private insurance, 29% had Medicare, 24% had Medicaid, and 16% were uninsured. Noninfectious, age-related diseases, such as hypertension, diabetes, and renal disease, were more frequent among persons with Medicare than among those with private insurance. Compared with those who were privately insured, mortality was greater among participants with Medicare [adjusted HR (HRadj) 1.35; 95% confidence interval (CI) 1.08–1.67; P = 0.008]. Among participants with a suppressed HIV viral load, compared with those who were privately insured, HRadj values for mortality were 1.93 (95% CI 1.08–3.44; P = 0.02) for those with Medicare and 2.09 (95% CI 1.02–4.27; P = 0.04) for those with Medicaid. Mortality among initially uninsured participants was not significantly different from that for privately insured participants, but these participants typically obtained ART and insurance during follow-up. Compared with privately insured participants, time-updated HRadj values for mortality were 1.34 (95% CI 1.05–1.70; P = 0.02) for those with Medicare, 1.34 (95% CI 1.01–1.80; P = 0.05) for those with Medicaid, and 1.35 (95% CI 0.97–1.88; P = 0.05) for those who were uninsured. Conclusions: In persons with AIDS, compared with those with private insurance, those with public insurance had increased mortality, possibly as a result of a greater burden of noninfectious, age-related diseases.
KW - AIDS
KW - health insurance
KW - mortality
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U2 - 10.1111/hiv.12531
DO - 10.1111/hiv.12531
M3 - Article
C2 - 28696029
AN - SCOPUS:85022332241
SN - 1464-2662
VL - 19
SP - 7
EP - 17
JO - HIV Medicine
JF - HIV Medicine
IS - 1
ER -