Primary Health Care System
RESEARCH AND KNOWLEDGE TRANSFER
RESEARCH FELLOWSHIP REPORTS
Population-based HIV Research Using Ontario's Administrative Databases
- Investigator:: Tony Antoniou
- Supervisor: Richard Glazier, University of Toronto
Background:
Because hospitalization of persons living with HIV-infection (PLWH) in the era of combination antiretroviral therapy (cART) may be an indicator of inadequate community-based care, population-based assessments of inpatient service utilization are a necessary component of the evaluation of the quality of HIV-related care.
Methods:
Using a validated algorithm, we identified all PLWH in Ontario’s administrative health-care databases aged 18 years and older between 1992 and 2008, and conducted a population-based study using ecologic and longitudinal individual-level analyses to quantify the immediate impact of cART on hospitalization rates and analyze recent trends (2002 to 2008) in rates of total and HIV-related hospitalizations.
Results:
The introduction of cART in 1996/97 was associated with more pronounced reductions in rates of total (-89.9 vs. -60.5 per 1000 PLWH; p = 0.003) and HIV-related hospitalizations (- 56.9 vs. -36.3 per 1000 PLWH; p < 0.001) among men relative to women. Between 2002 and 2008, higher rates of total hospitalization were associated with female sex [adjusted relative rate (aRR) 1.15; 95% CI: 1.05 to 1.27] and low socioeconomic status (aRR 1.21; 95% CI: 1.14 to 1.29). Higher rates of HIV-related hospitalizations were associated with low socioeconomic status (aRR 1.30; 95% CI: 1.17 to 1.45). Recent immigrants had lower rates of both total (aRR 0.70; 95% CI 0.61 to 0.80) and HIV-related hospitalizations (aRR 0.77; 95% CI 0.60 to 0.96).
Interpretation:
We observed important gender- and socioeconomic-based disparities in hospitalization rates among PLWH living in Ontario, Canada
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