Analysis of a population-based Pneumocystis carinii pneumonia index as an outcome measure of access and quality of care for the treatment of HIV disease

The Incidence, Prevalence and Mortality Rates of Black and White Persons with HIV in the United States in 2019

INTRODUCTION

This study examines the experience of non-Hispanic Black Americans (hereinafter referred to as Black persons) and non-Hispanic White Americans (hereinafter referred to as White persons) with regard to the incidence (i.e., number of persons diagnosed with HIV), prevalence (i.e., number of persons living with HIV), and mortality rates of persons with HIV in the United States in 2019. With regard to mortality rates, this study examines the mortality rate of all Black persons and White persons with HIV in 2019 as well as the mortality rate of hospitalized Black persons and White persons with HIV in 2019.

METHODS

Data on the racial characteristics of all persons in the United States in 2019 were obtained from the United States Census Bureau, and data on the racial characteristics of all persons with HIV in the United States were obtained from HIV Surveillance Reports produced by the Centers for Disease Control and Prevention (CDC). In addition, data on all hospital patients in seven states (California, Florida, Michigan, New Jersey, New York, South Carolina and Wisconsin) in 2019 were obtained from the Agency for Healthcare Research and Quality (AHRQ) Hospital Cost and Utilization Project (HCUP) State Inpatient Database (SID). These seven states included 44 percent of all persons living with HIV in the United States in 2019.

RESULTS

This study found that Black persons were more likely to be diagnosed with HIV, live with HIV, and die with HIV than White persons in the United States. This is illustrated by the fact that in 2019 Black persons comprised 13.4 percent of the population, yet they comprised 42.1 percent of persons diagnosed with HIV, 40.4 percent of persons living with HIV, and 42.9 percent of persons who died with HIV. By comparison, in 2019 White persons comprised 76.3 percent of the population, yet they comprised 24.8 percent of persons diagnosed with HIV, 29.1 percent of persons living with HIV, and 31.8 percent of persons who died with HIV. Nevertheless, this study did not find a statistically significant difference between the in-hospital mortality rates of Black and White persons in seven states in 2019.

CONCLUSIONS

The burden of HIV was considerably greater on Black persons than White persons in the United States in 2019.

Access to cardiac interventional services in Alabama and Mississippi: a geographical information system analysis

OBJECTIVE

The objective of this study was to determine the contribution of distance to hospitals with cardiac interventional services (CIS) to county age-adjusted myocardial infarction (MI) mortality rates (CAMR) in Alabama and Mississippi counties.

METHODS

THE STUDY USED THREE DATA SOURCES: U.S. Census data, Centers for Disease Control and Prevention (CDC) mortality data, and American Hospital Association data. A geographical information system (GIS) was used to measure distance, providing an empirical measure of county access to CIS. Multiple regression analysis was conducted using measures of distance to CIS, county rural status, state, sex, poverty, education, race, and interaction as predictors of CAMR.

RESULTS

Regression results indicate that the model significantly predicts CAMR, R(2) = .378, adjusted R(2) = .319, F = 6.321, p < .001. The model accounts for 31.9 percent of the variability.

CONCLUSIONS

The results of this study do not lead to the conclusion that cardiac outcomes as measured by CAMR were sensitive to the geographic location of CIS. However, statistically significant interactions supported the sensitivity of CAMR to complex patterns and issues of rural status, poverty, education, and race.

Clinical and epidemiological analysis of patients with HIV/AIDS admitted to a reference hospital in the northeast region of Brazil

The AIDS epidemic has become a worldwide phenomenon of enormous magnitude and extension, deeply transforming medical practices and public health initiatives. This retrospective survey aimed to analyze clinical and epidemiological characteristics of patients with HIV/AIDS admitted to the Institute of Tropical Diseases Natan Portella, Teresina, Piauí, Brazil, from January, 2001 through December, 2004. Of the 828 patients, 43% were from other states and 71.3% were men. Average patient age was 35.4 +/- 11.5 years-old and 85.5% were illiterate or had primary education. The main form of exposure to HIV was heterosexual behavior (54.1%), while injectable drug use was confirmed by only 2.7% of registered cases. The most frequent infectious complications were candidiasis (42.4%) and pneumocystosis (22.2%). Sixty-eight cases (8.2%) of visceral leishmaniasis were registered. Using multivariate analysis, individuals aged over 40 years-old, patients with active tuberculosis, Pneumocystis carinii pneumonia and central nervous system cryptococcosis showed increased risk of death. In this study, young male adults with low educational levels predominated and the most frequent opportunistic infections were candidiasis and pneumocystosis.

Integrative literature review: a review of literature related to geographical information systems, healthcare access, and health outcomes

Differences in access to healthcare services and the resulting adverse health outcomes are major public health priorities. The Institute of Medicine and the Department of Health and Human Services have identified the need for strategies to improve access to healthcare services and to support the improvement of health outcomes. The literature documents health disparities associated with healthcare access and health outcomes from a geographic perspective. Place of residence, location of healthcare services, and geography in general are important factors in the analysis of health. Geographical information systems (GISs) are an emerging technology in the analysis of health from a geographical or location context. As a type of information technology, GISs are potentially powerful assessment tools for the investigation of healthcare access, health outcomes, and the possible resulting health disparities. Their ability to integrate health data with mapping functions allows for visualization, exploration, and modeling of health patterns. Application of GIS technology using health data can help in describing and explaining disparities in healthcare access and health outcomes. The studies reviewed demonstrated the use of GISs to investigate various aspects of healthcare access and health outcomes, including environmental variables of Lyme disease, sociodemographic variables and teen pregnancy, geographical disparities in breast cancer mortality by racial groups, PCP and AIDS prevalence, and factors of a leptospirosis disease outbreak. The literature reviewed shows effective integration and analysis of health data using GIS technology.

Policy and programmatic importance of spatial alignment of data sources

Geographic information systems have proven instrumental in assessing environmental impacts on individual and community health, but numerous methodological challenges are associated with analyses of highly localized phenomena in which spatially misaligned data are used. In a case study based on child care facility and traffic data for the Los Angeles metropolitan area, we assessed the extent of facility misclassification with spatially unreconciled data from 3 different governmental agencies in an attempt to identify child care centers in which young children are at risk from high concentrations of toxic vehicle-exhaust pollutants. Relative to geographically corrected data, unreconciled information produced a modest bias in terms of aggregated number of facilities at risk and a substantial number of false positives and negatives.

US hospital care for patients with HIV infection and pneumonia: the role of public, private, and Veterans Affairs hospitals in the early highly active antiretroviral therapy era

STUDY OBJECTIVES

We evaluated differences in processes and outcomes of HIV-related pneumonia care among patients in Veterans Affairs (VA), public, and for-profit and not-for-profit private hospitals in the United States. We compared the results of our current study (1995 to 1997) with those of our previous study that included a sample of patients receiving care during the years 1987 to 1990 to determine how HIV-related pneumonia care had evolved over the last decade.

SETTING/PATIENTS

The sample consisted of 1,231 patients with HIV infection who received care for Pneumocystis carinii pneumonia (PCP) and 750 patients with HIV infection who received care for community-acquired pneumonia (CAP) during the years 1995 to 1997.

MEASUREMENT

We conducted a retrospective medical record review and evaluated patient and hospital characteristics, HIV-related processes of care (timely use of anti-PCP medications, adjunctive corticosteroids), non-HIV-related processes of care (timely use of CAP treatment medications, diagnostic testing, ICU utilization, rates of endotracheal ventilation, placement on respiratory isolation), length of inpatient hospital stay, and inpatient mortality.

RESULTS

Rates of timely use of antibiotics and adjunctive corticosteroids for treating PCP were high and improved dramatically from the prior decade. However, compliance with consensus guidelines that recommend < 8 h as the optimal time window for initiation of antibiotics to treat CAP was lower. For both PCP and CAP, variations in processes of care and lengths of in-hospital stays, but not mortality rates, were noted at VA, public, private not-for-profit hospitals, and for-profit hospitals.

CONCLUSIONS

This study provides the first overview of HIV-related pneumonia care in the early highly active antiretroviral therapy era, and contrasts current findings with those of a similarly conducted study from a decade earlier. Quality of care for patients with PCP improved, but further efforts are needed to facilitate the appropriate management of CAP. In the third decade of the epidemic, it will be important to monitor whether variations in processes of care for various HIV-related clinical diagnoses among different types of hospitals persist.

Income inequality and infant mortality in New York City

A series of studies have demonstrated that people who live in regions where there are disparities in income have poorer average health status than people who live in more economically homogeneous regions. To test whether such disparities might explain health variations within urban areas, we examined the possible association between income inequality and infant mortality for zip code regions within New York City using data from the 1990 census and the New York City Department of Health. Both infant mortality and income inequality (percentage of income received by the poorest 50% of households) varied widely across these regions (range in infant mortality: 0.6-29.6/1,000 live births; range in income inequality: 12.7-27.3). An increase of one standard deviation in income inequality was associated with an increase of 0.80 deaths/1,000 live births (P <.001), controlling for other socioeconomic factors. This finding has important implications for public health practice and social epidemiological research in large urban areas, which face significant disparities both in health and in social and economic conditions.