Determinants of hospital admission among HIV-positive people in British Columbia

Background: This study was initiated to evaluate the demographic and clinic al determinants of admission to hospital among HIV-positive men and women r eceiving antiretroviral therapy in British Columbia. Methods: The analysis was restricted to participants enrolled in the HIV/AI DS Drug Treatment Program between September 1992 and March 1997 who had com pleted an annual participant survey, had a viral load determination and had signed a consent form allowing electronic access to their inpatient hospit al records. A record linkage was conducted with the BC Ministry of Health t o obtain all records of hospital admissions from April 1991 to March 1997. Statistical analyses were carried out using parametric and nonparametric me thods and multivariate logistic analyses. Results: The study sample comprised 947 participants (859 men, 88 women). O f these, 165 (17%) were admitted to hospital during the study period from M ay 1, 1996, to Mar. 31, 1997. The median number of admissions was 1 (interq uartile range [IQR] 1-2 admissions), and the median length of stay per admi ssion was 3 days (IQR 1-8 days). Admission to hospital was associated With being unemployed (82% of those admitted v. 58% of those not admitted), bein g an injection drug user (24% v. 17%), reporting a fair or poor health stat us (46% v. 29%) and having a physician experienced in the management of HIV /AIDS (31% v. 24%). Examination of clinical determinants demonstrated that hospital admission was associated with a previous admission (72% v. 46%), a high viral load (median 74 000 v. 14 000 HIV-1 RNA copies/mL), a low CD4 c ount (median 0.16 v. 0.27 x 10(9)/L) and an AIDS diagnosis (44% v. 24%). Mu ltivariate logistic regression analysis revealed that being admitted to hos pital was independently associated with being unemployed (odds ratio [OR] 2 .64, 95% confidence interval [CI] 1.66-4.20), having been previously admitt ed to hospital (OR 2.30, 95% CI 1.53-3.46), having a high viral load at bas eline (OR 1.45, 95% CI 1.16-1.80), being an injection drug user (OR 1.63, 9 5% CI 1.02-2.62) and having an experienced physician (OR 1.98, 95% CI 1.29- 3.03). Interpretation: Hospital admission among participants in this study Was fou nd to be associated with marginalization and poor health status.