Insurance status and mortality among patients with AIDS

• Published in: HIV medicine Vol. 19; no. 1; pp. 7 - 17
• Main Authors: Jabs, AW, Jabs, DA, Van Natta, ML, Palella, FJ, Meinert, CL
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.01.2018
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - mortality; Adolescent; Adult; Age; Aged; Aged, 80 and over; AIDS; Antiretroviral agents; Antiretroviral therapy; Complications; Confidence intervals; Correlation analysis; Diabetes mellitus; Female; Government programs; Hazards; Health care; health insurance; HIV; Human immunodeficiency virus; Humans; Hypertension; Insurance; Insurance Coverage; Kidney transplantation; Longitudinal Studies; Male; Medicare; Middle Aged; Mortality; Patients; Prospective Studies; Regression analysis; Regression models; Risk analysis; Risk Factors; Statistical analysis; Uninsured people; Young Adult; mortality; health insurance; AIDS
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.12531

Objectives The aim of the study was to evaluate risk factors for mortality, including health care insurance status, among patients with AIDS in the era of modern combination antiretroviral therapy (cART). Methods This study was part of the prospective, multicentre, observational Longitudinal Study of the Ocular Complications of AIDS (LSOCA). Patients were classified as having private health care insurance, Medicare, Medicaid, or no insurance. Hazard ratios (HRs) for death were calculated using proportional hazards regression models and staggered entries, anchored to the AIDS diagnosis date. Results Among 2363 participants with AIDS, 97% were treated with cART. At enrolment, 31% of participants had private insurance, 29% had Medicare, 24% had Medicaid, and 16% were uninsured. Noninfectious, age‐related diseases, such as hypertension, diabetes, and renal disease, were more frequent among persons with Medicare than among those with private insurance. Compared with those who were privately insured, mortality was greater among participants with Medicare [adjusted HR (HRadj) 1.35; 95% confidence interval (CI) 1.08–1.67; P = 0.008]. Among participants with a suppressed HIV viral load, compared with those who were privately insured, HRadj values for mortality were 1.93 (95% CI 1.08–3.44; P = 0.02) for those with Medicare and 2.09 (95% CI 1.02–4.27; P = 0.04) for those with Medicaid. Mortality among initially uninsured participants was not significantly different from that for privately insured participants, but these participants typically obtained ART and insurance during follow‐up. Compared with privately insured participants, time‐updated HRadj values for mortality were 1.34 (95% CI 1.05–1.70; P = 0.02) for those with Medicare, 1.34 (95% CI 1.01–1.80; P = 0.05) for those with Medicaid, and 1.35 (95% CI 0.97–1.88; P = 0.05) for those who were uninsured. Conclusions In persons with AIDS, compared with those with private insurance, those with public insurance had increased mortality, possibly as a result of a greater burden of noninfectious, age‐related diseases.