Bj. Turner et al., Delayed medical care after diagnosis in a US national probability sample of persons infected with human immunodeficiency virus, ARCH IN MED, 160(17), 2000, pp. 2614-2622
Citations number
34
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Objective: To identify health care and patient factors associated with dela
yed initial medical care for human immunodeficiency virus (HIV) infection.
Design: Survey of a national probability sample of persons with HIV in care
.
Settings Medical practices in the contiguous United States.
Patients: Cohort A (N=1540) was diagnosed by February 1993 and was in care
within 3 years; cohort B (N=1960) was diagnosed by February 1995 and was in
care within 1 year of diagnosis.
Main Outcome Measure: More than 3- or 6-month delay.
Results: Delay of more than 3 months occurred for 29% of cohort A (median,
1 year) and 17% of cohort B. Having a usual source of care at diagnosis red
uced delay, with adjusted odds ratios (ORs) of 0.61 (95% confidence interva
l [CI], 0.48-0.77) in cohort A and 0.70 (95% CI, 0.50-0.99) in cohort B. Me
dicaid coverage at diagnosis showed lower adjusted ORs of delay compared wi
th private insurance (cohort A: adjusted OR, 0.52; 95% CI, 0.30-0.92; cohor
t B: adjusted OR, 0.48; 95%, CI, 0.27-0.85). Compared with whites, Latinos
had 53%, and 95% higher adjusted ORs of delay (P<.05) in cohorts A and B, r
espectively, and African Americans had a higher adjusted OR in cohort A (1.
56; 95%, CI, 1.19-2.04). The health care factors showed similar effects on
delay of greater than 6 months.
Conclusions: Medicaid insurance and a usual source of care were protective
against delay after HIV diagnosis. After full adjustment, delay was still g
reater for Latinos and, to a lesser extent, African Americans compared with
whites.