Is there a race-based disparity in the survival of veterans with HIV?

Thomas P. Giordano, Robert O. Morgan, Jennifer R. Kramer, Christine Hartman, Peter Richardson, A. Clinton White, Maria E. Suarez-Almazor, Hashem B. El-Serag

Research output: Contribution to journal › Article

17 Citations (Scopus)

Abstract

BACKGROUND: Disparities in survival for black patients with HIV in the United States have been reported. The VA is an equal access health care system. OBJECTIVE: To determine whether such disparities are present in the VA health care system. DESIGN: Retrospective cohort study using national VA administrative databases. PATIENTS: Two thousand three hundred and four white and 3,641 black HIV-infected patients first hospitalized for HIV between October 1, 1996 and September 30, 2000. MEASUREMENTS: Thirty-day mortality after first hospitalization with HIV, and subsequent long-term survival. Follow-up ended at death or September 30, 2002. Data were adjusted for age, sex, HIV disease severity, non-HIV-related comorbidities, primary discharge diagnosis, hepatitis C status, and facility effects. RESULTS: The mean follow-up was 3.2 years. Overall survival was similar for black patients compared with white patients (adjusted hazard ratio 1.09, P=.09). Hospital mortality was 7.0% for black and 6.4% for white patients (P=.35). Adjusted hospital mortality for black patients was similar to that of white patients (odds ratio 1.20, P=.10). Long-term survival after hospitalization did not significantly differ by race (adjusted hazard ratio 1.07, P=.21, for black patients compared with white patients). CONCLUSIONS: Survival during and after first hospitalization with HIV in the VA did not significantly differ for white and black patients, possibly indicating similar effectiveness of care for HIV. Further research is needed to understand the reasons for the lack of disparities for VA patients with HIV and whether the VA's results could be replicated.

Original languageEnglish (US)
Pages (from-to)613-617
Number of pages5
JournalJournal of General Internal Medicine
Volume21
Issue number6
DOIs
StatePublished - Jun 2006
Externally publishedYes

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Veterans
HIV
Survival
Hospitalization
Hospital Mortality
Delivery of Health Care
Hepatitis C
Comorbidity
Cohort Studies
Retrospective Studies
Odds Ratio
Databases

Keywords

  • Cohort study
  • Health disparities
  • HIV/AIDS
  • Race
  • Survival
  • Veterans affairs

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Giordano, T. P., Morgan, R. O., Kramer, J. R., Hartman, C., Richardson, P., White, A. C., ... El-Serag, H. B. (2006). Is there a race-based disparity in the survival of veterans with HIV? Journal of General Internal Medicine, 21(6), 613-617. https://doi.org/10.1111/j.1525-1497.2006.00452.x

Is there a race-based disparity in the survival of veterans with HIV? / Giordano, Thomas P.; Morgan, Robert O.; Kramer, Jennifer R.; Hartman, Christine; Richardson, Peter; White, A. Clinton; Suarez-Almazor, Maria E.; El-Serag, Hashem B.

In: Journal of General Internal Medicine, Vol. 21, No. 6, 06.2006, p. 613-617.

Research output: Contribution to journal › Article

Giordano, TP, Morgan, RO, Kramer, JR, Hartman, C, Richardson, P, White, AC, Suarez-Almazor, ME & El-Serag, HB 2006, 'Is there a race-based disparity in the survival of veterans with HIV?', Journal of General Internal Medicine, vol. 21, no. 6, pp. 613-617. https://doi.org/10.1111/j.1525-1497.2006.00452.x
Giordano TP, Morgan RO, Kramer JR, Hartman C, Richardson P, White AC et al. Is there a race-based disparity in the survival of veterans with HIV? Journal of General Internal Medicine. 2006 Jun;21(6):613-617. https://doi.org/10.1111/j.1525-1497.2006.00452.x
Giordano, Thomas P. ; Morgan, Robert O. ; Kramer, Jennifer R. ; Hartman, Christine ; Richardson, Peter ; White, A. Clinton ; Suarez-Almazor, Maria E. ; El-Serag, Hashem B. / Is there a race-based disparity in the survival of veterans with HIV?. In: Journal of General Internal Medicine. 2006 ; Vol. 21, No. 6. pp. 613-617.
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abstract = "BACKGROUND: Disparities in survival for black patients with HIV in the United States have been reported. The VA is an equal access health care system. OBJECTIVE: To determine whether such disparities are present in the VA health care system. DESIGN: Retrospective cohort study using national VA administrative databases. PATIENTS: Two thousand three hundred and four white and 3,641 black HIV-infected patients first hospitalized for HIV between October 1, 1996 and September 30, 2000. MEASUREMENTS: Thirty-day mortality after first hospitalization with HIV, and subsequent long-term survival. Follow-up ended at death or September 30, 2002. Data were adjusted for age, sex, HIV disease severity, non-HIV-related comorbidities, primary discharge diagnosis, hepatitis C status, and facility effects. RESULTS: The mean follow-up was 3.2 years. Overall survival was similar for black patients compared with white patients (adjusted hazard ratio 1.09, P=.09). Hospital mortality was 7.0{\%} for black and 6.4{\%} for white patients (P=.35). Adjusted hospital mortality for black patients was similar to that of white patients (odds ratio 1.20, P=.10). Long-term survival after hospitalization did not significantly differ by race (adjusted hazard ratio 1.07, P=.21, for black patients compared with white patients). CONCLUSIONS: Survival during and after first hospitalization with HIV in the VA did not significantly differ for white and black patients, possibly indicating similar effectiveness of care for HIV. Further research is needed to understand the reasons for the lack of disparities for VA patients with HIV and whether the VA's results could be replicated.",
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