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A Population-Based Analysis

Barbara J. Turner, MD, MSEd; Stephen C. Eppes, MD; Leona E. Markson, ScD; Linda J. McKee, MHS; Thomas R. Fanning, PhD; Robert H. Pantell, MD

Arch Pediatr Adolesc Med. 1996;150(6):615-622.

Abstract
Objectives
To compare the use of medical services by pediatric and adult patients with acquired immunodeficiency syndrome (AIDS) in the 6 months before and after the diagnosis of AIDS when demand for care is often high and to study the influence of human immunodeficiency virus specialty care on survival of pediatric patients.

Design
Retrospective analysis of Medicaid files.

Setting
New York State Medicaid Program.

Patients
A cohort identified as having AIDS from 1985 through 1990 and enrolled on Medicaid from birth or 1 year or more before diagnosis. Because of differing prognoses, 3 groups were studied by age at the time that AIDS was diagnosed: infants younger than 6 months, children aged 6 months to 12 years, and adults aged 13 to 60 years.

Main Outcome Measures
Frequencies of any service use and, among users, monthly rates of services. From Cox proportional hazards models, the adjusted hazard of death for human immunodeficiency virus specialty ambulatory care.

Results
Nearly all infants (n=122) were hospitalized before and after the diagnosis of AIDS was made—the most of all groups. After diagnosis, only 81% of older children (n=612) were hospitalized vs 93% of infants and 90% of adults (n=5602). Hospitalized children had a median of only 3.3 inpatient days per month vs 12.3 and 7.8 inpatient days for infants and adults, respectively. Of older children, 45% used the emergency department vs 33% of adults. Human immunodeficiency virus specialty care for infants and children was associated with a 40% lower risk of death after the diagnosis of AIDS.

Conclusions
In this AIDS cohort, infants had the greatest use of inpatient care, and older children used the emergency department more than adults. The finding of improved survival for infants and children with human immunodeficiency virus specialty care warrants further study in more recent years.

(Arch Pediatr Adolesc Med. 1996;150:615-622)

Author Affiliations
From the Division of General Internal Medicine and Center for Research in Medical Education and Health Care (Drs Turner and Markson), Division of Clinical Pharmacology (Ms McKee), and Department of Pediatrics (Dr Eppes), Jefferson Medical College, Philadelphia, Pa; the Alfred I. duPont Institute, Wilmington, Del (Dr Eppes); the New York State Department of Social Services, Albany (Dr Fanning); and the Department of Pediatrics, University of California–San Francisco (Dr Pantell).

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