RELATION BETWEEN HOSPITAL HIV AIDS CASELOAD AND MORTALITY AMONG PERSONS WITH HIV/AIDS IN CANADA/

Objective: To assess the relation between HIV/AIDS hospital caseload a nd mortality in Canada. Design: Descriptive, population-based study. S etting: All hospitals in Canada that admitted any patients with HIV or AIDS between Mar. 31, 1987, and Apr. 1, 1994. Patients: All patients with a diagnostic code on their hospital discharge abstract for HIV in fection, AIDS, or with positive serological or viral culture findings for HN (International Classification of Diseases, 9th revision, 042, 0 43, 044 or 795.8). Main outcome measure: In-hospital mortality. Result s: Over the study period, 38 075 admissions amibuted to HIV/AIDS (33 3 80 of men and 4695 of women) were recorded in 513 Canadian hospitals. Of these hospitals, 230 (45%) had fewer than 1 admission per year of p atients with HIV/AIDS; 200 (39%) had between 1 and 9; 68 (13%) had bet ween 10 and 99; and 15 (3%) had 100 or more. HIV/AIDS-related admissio ns ending in death were independently associated with the patient bein g admitted to lower-volume hospitals, being hospitalized for longer pe riods of time, and being older, male and at a more advanced stage of d isease. During the study period, hospitals with 100 or more admissions per year reported 36% lower mortality among patients with HIV/AIDS th an those that had fewer than 1 admission per year. Conclusion: There i s an inverse relation between hospital caseload and in-hospital mortal ity among patients with HIV/AIDS in Canada. We attribute this associat ion at least in part to the propensity of high-volume hospitals to dea l more effectively with seriously ill patients with HIV/AIDS.