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Walkup J, Thomas MD, Vittinghoff E, Hermida R, Crystal S, Arnold EA, Dahiya P, Olfson M, Cournos F, Dawson L, Dilley J, Bazazi A, Mangurian C. Characteristics and Trends in HIV Testing Among Medicaid Enrollees Diagnosed as Having Schizophrenia. Psychiatr Serv 2023; 74:709-717. [PMID: 36852552 PMCID: PMC10329993 DOI: 10.1176/appi.ps.20220311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE People with schizophrenia have more HIV risk factors and higher rates of HIV infection than the general U.S. population. The authors aimed to examine HIV testing patterns in this population nationally and by demographic characteristics and presence of high-risk comorbid conditions. METHODS This retrospective longitudinal study compared HIV testing between Medicaid-only enrollees with schizophrenia and without schizophrenia during 2002-2012 (N=6,849,351). Interrupted time series were used to analyze the impacts of the 2006 federal policy change recommending expanded HIV testing. Among enrollees with schizophrenia, multivariable logistic regression was used to estimate associations between testing and both demographic characteristics and comorbid conditions. Sensitivity analyses were also conducted. RESULTS Enrollees diagnosed as having schizophrenia had consistently higher HIV testing rates than those without schizophrenia. When those with comorbid substance use disorders or sexually transmitted infections were excluded, testing was higher for individuals without schizophrenia (p<0.001). The federal policy change likely increased testing for both groups (p<0.001), but the net change was greater for those without schizophrenia (3.1 vs. 2.2 percentage points). Among enrollees with schizophrenia, testing rates doubled during 2002-2012 (3.9% to 7.2%), varied across states (range 17 percentage points), and tripled for those with at least one annual nonpsychiatric medical visit (vs. no visit; adjusted OR=3.10, 95% CI=2.99-3.22). CONCLUSIONS Nationally, <10% of enrollees with schizophrenia had annual HIV testing. Increases appear to be driven by high-risk comorbid conditions and nonpsychiatric encounters, rather than by efforts to target people with schizophrenia. Psychiatric guidelines for schizophrenia care should consider HIV testing alongside annual metabolic screening.
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Affiliation(s)
- James Walkup
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Marilyn D Thomas
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Eric Vittinghoff
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Richard Hermida
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Emily A Arnold
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Priya Dahiya
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Mark Olfson
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Francine Cournos
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Lindsey Dawson
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - James Dilley
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Alexander Bazazi
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Christina Mangurian
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
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Moonesinghe R, Fleming E, Truman BI, Dean HD. Linear and non-linear associations of gonorrhea diagnosis rates with social determinants of health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012. [PMID: 23202676 PMCID: PMC3499859 DOI: 10.3390/ijerph9093149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Identifying how social determinants of health (SDH) influence the burden of disease in communities and populations is critically important to determine how to target public health interventions and move toward health equity. A holistic approach to disease prevention involves understanding the combined effects of individual, social, health system, and environmental determinants on geographic area-based disease burden. Using 2006–2008 gonorrhea surveillance data from the National Notifiable Sexually Transmitted Disease Surveillance and SDH variables from the American Community Survey, we calculated the diagnosis rate for each geographic area and analyzed the associations between those rates and the SDH and demographic variables. The estimated product moment correlation (PMC) between gonorrhea rate and SDH variables ranged from 0.11 to 0.83. Proportions of the population that were black, of minority race/ethnicity, and unmarried, were each strongly correlated with gonorrhea diagnosis rates. The population density, female proportion, and proportion below the poverty level were moderately correlated with gonorrhea diagnosis rate. To better understand relationships among SDH, demographic variables, and gonorrhea diagnosis rates, more geographic area-based estimates of additional variables are required. With the availability of more SDH variables and methods that distinguish linear from non-linear associations, geographic area-based analysis of disease incidence and SDH can add value to public health prevention and control programs.
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Affiliation(s)
- Ramal Moonesinghe
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA; (E.F.); (B.I.T.); (H.D.D.)
- Author to whom correspondence should be addressed; ; Tel.: +1-770-488-8203; Fax: +1-770-488-8336
| | - Eleanor Fleming
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA; (E.F.); (B.I.T.); (H.D.D.)
- Centers for Disease Control and Prevention, Division of Applied Sciences, Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Atlanta, GA 30333, USA
| | - Benedict I. Truman
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA; (E.F.); (B.I.T.); (H.D.D.)
| | - Hazel D. Dean
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA; (E.F.); (B.I.T.); (H.D.D.)
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