The rates at which AIDS patients die and use hospitals vary substantially across States and among racial/ethnic groups within States, even after controlling for severity of illness, according to the first State-wide study of the issue by Fred J. Hellinger, Ph.D., and John A. Fleishman, Ph.D., of the Agency for Healthcare Research and Quality. They analyzed 1996 data on all AIDS-related hospitalizations (120,772) in 10 States.
The most AIDS-related hospital admissions per AIDS patient were in New York, with a ratio of 1.11. Maryland, Pennsylvania, and Iowa also had ratios above 1.0, suggesting that multiple admissions may be occurring for some people with AIDS. Rates in Colorado and California were notably smaller. New York also had the longest average length of hospital stay (12.4 days) followed by New Jersey (11.3 days); Colorado had the shortest length of stay (6 days).
Over all 10 States, admission rates per AIDS patient were .689 for whites, 1.02 for blacks, and .657 for Hispanics. Admission rates for blacks were higher than for whites in all States except Iowa and New Jersey, and admission rates for whites were higher than for Hispanics in all States except California and Colorado. Blacks and Hispanics had longer hospital stays and were more likely to die while in the hospital than whites. These racial/ethnic differences persisted even after controlling for insurance coverage and severity of illness and may reflect barriers faced by minorities in accessing outpatient services that typically reduce or prevent AIDS-related hospitalizations.
The probability that an AIDS-related hospital admission would end in death was highest in South Carolina and lowest in Colorado (10 vs. 5.7 percent). Most States had probabilities of death between 7 and 8 percent. AIDS patients in States with enhanced Medicaid HIV reimbursement rates or a home and community-based waiver program (which provides AIDS patients with services intended to reduce hospital stays) had lower odds of dying in the hospital.
More details are in "Location, race, and hospital care for AIDS patients: An analysis of 10 States," by Drs. Hellinger and Fleishman, in the Fall 2001 Inquiry 38, pp. 319-330.
Reprints (AHRQ Publication 02-R028) are available from the AHRQ Publications Clearinghouse and AHRQ InstantFax.