Hospital readmissions among adults living with and without HIV in the US: findings from the Nationwide Readmissions DatabaseResearch in context

Xianming Zhu; Eshan U. Patel; Stephen A. Berry; Mary K. Grabowski; Alison G. Abraham; Thibaut Davy-Mendez; Brenna Hogan; Keri N. Althoff; Andrew D. Redd; Oliver Laeyendecker; Thomas C. Quinn; Kelly A. Gebo; Aaron A.R. Tobian

EClinicalMedicine (Jul 2024)

Hospital readmissions among adults living with and without HIV in the US: findings from the Nationwide Readmissions DatabaseResearch in context

Xianming Zhu,
Eshan U. Patel,
Stephen A. Berry,
Mary K. Grabowski,
Alison G. Abraham,
Thibaut Davy-Mendez,
Brenna Hogan,
Keri N. Althoff,
Andrew D. Redd,
Oliver Laeyendecker,
Thomas C. Quinn,
Kelly A. Gebo,
Aaron A.R. Tobian

Affiliations

Xianming Zhu: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Eshan U. Patel: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
Stephen A. Berry: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Mary K. Grabowski: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
Alison G. Abraham: Department of Epidemiology, Colorado School of Public Heath, Aurora, CO, USA
Thibaut Davy-Mendez: Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
Brenna Hogan: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
Keri N. Althoff: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
Andrew D. Redd: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
Oliver Laeyendecker: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
Thomas C. Quinn: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
Kelly A. Gebo: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Aaron A.R. Tobian: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Corresponding author. Department of Pathology, School of Medicine, Johns Hopkins University, Carnegie 437, 600 N. Wolfe St., Baltimore, MD 21287, USA.

Journal volume & issue: Vol. 73
p. 102690

Abstract

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Summary: Background: Thirty-day hospital readmission measures quality of care, but there are limited data among people with HIV (PWH) and people without HIV (PWoH) in the era of universal recommendation for antiretroviral therapy. We descriptively compared 30-day all-cause, unplanned readmission risk between PWH and PWoH. Methods: A retrospective cohort study was conducted using the 2019 Nationwide Readmissions Database (2019/01/01–2019/12/31), an all-payer database that represents all US hospitalizations. Index (initial) admissions and readmissions were determined using US Centers for Medicare & Medicaid Services definitions. Crude and age-adjusted risk ratios (aRR) comparing the 30-day all-cause, unplanned readmission risk between PWH to PWoH were estimated using random effect logistic regressions and predicted marginal estimates. Survey weights were applied to all analyses. Findings: We included 24,338,782 index admissions from 18,240,176 individuals. The median age was 52(IQR = 40–60) years for PWH and 61(IQR = 38–74) years for PWoH. The readmission risk was 20.9% for PWH and 12.2% for PWoH (age-adjusted-RR:1.88 [95%CI = 1.84–1.92]). Stratified by age and sex, young female (age 18–29 and 30–39 years) PWH had a higher readmission risk than young female PWoH (aRR = 3.50 [95%CI = 3.11–3.88] and aRR = 4.00 [95%CI = 3.67–4.32], respectively). While the readmission risk increased with age among PWoH, the readmission risk was persistently high across all age groups among PWH. The readmission risk exceeded 30% for PWH admitted for hypertensive heart disease, heart failure, and chronic kidney disease. Interpretation: PWH have a disproportionately higher risk of readmission than PWoH, which is concerning given the aging profile of PWH. More efforts are needed to address readmissions among PWH. Funding: US National Institutes of Health.

Published in EClinicalMedicine

ISSN: 2589-5370 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Medicine (General)
Website: https://www.thelancet.com/journals/eclinm/home

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