Document 0266
 DOCN  M9460266
 TI    Impact of immunosuppression on health care use by men in the Multicenter
       AIDS Cohort Study (MACS).
 DT    9408
 AU    Zucconi SL; Jacobson LP; Schrager LK; Kass NE; Lave JR; Carson CA;
       Morgenstern H; Arno PS; Graham NM; Health Policy Institute, Graduate
       School of Public Health,; University of Pittsburgh, PA 15261.
 SO    J Acquir Immune Defic Syndr. 1994 Jun;7(6):607-16. Unique Identifier :
       AIDSLINE MED/94231466
 AB    The effects of human immunodeficiency virus type 1 (HIV-1) serostatus,
       AIDS, and level of immunosuppression on health service use were examined
       in the Multicenter AIDS Cohort Study. Data on self-reported
       hospitalizations, outpatient medical services (non-emergency room) and
       emergency room care during the preceding 6 months were collected for
       3,447 homosexual/bisexual men returning for their 14th and/or 15th
       semiannual visits in Chicago, Baltimore, Los Angeles, and Pittsburgh.
       AIDS-free seropositive men with CD4+ cells < 200/microliters were more
       likely to be hospitalized [odds ratio (OR) = 2.3, 95% confidence limits
       (CL) = 1.4, 3.8] and use outpatient medical care (OR = 7.9, 95% CL =
       4.9, 12.6), compared with seronegative men. Increased outpatient care
       was initiated at the earliest stages of HIV-1 infection, even when CD4+
       cells were > 500/microliter. Dramatic increases in outpatient care for
       each level of immunosuppression were observed. HIV-1-related symptoms
       were associated with increased hospitalizations (OR = 4.8, 95% CL = 3.2,
       7.3), use of outpatient medical services (OR = 3.3, 95% CL = 1.9, 5.6),
       and emergency room care (OR = 3.1, 95% CL = 2.1, 4.6). Persons with AIDS
       and < or = 50 CD4+ cells/microliter most likely to be hospitalized (OR =
       8.1; 95% CL = 4.4, 14.9). No significant difference (p > 0.05) in
       emergency room use was observed according to HIV-1 serostatus, AIDS, or
       immunosuppression, after adjusting for insurance and clinical symptoms.
       To the extent that CD4+ cell counts are used as one of the criteria for
       an AIDS diagnosis and such a diagnosis broadens available benefits to
       persons with HIV disease, the pattern of health care services described
       here will be important for health care providers and planners.
 DE    Acquired Immunodeficiency Syndrome/*ECONOMICS  Adult  Ambulatory
       Care/UTILIZATION  Bisexuality  Cohort Studies  Emergency Medical
       Services/STATISTICS & NUMER DATA  Health Services/*UTILIZATION
       Homosexuality  Hospitalization/STATISTICS & NUMER DATA  Human  HIV
       Seropositivity/*ECONOMICS  Income  Insurance, Health  Leukocyte Count
       Male  Middle Age  Odds Ratio  Prospective Studies  Regression Analysis
       Support, U.S. Gov't, P.H.S.  T4 Lymphocytes  United States  JOURNAL
       ARTICLE  MULTICENTER STUDY

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).