Health care of children and adults with acquired immunodeficiency syndrome. A population-based analysis
B. J. Turner, S. C. Eppes, L. E. Markson, L. J. McKee, T. R. Fanning and R. H. Pantell
Division of General Internal Medicine, Jefferson Medical College, Philadelphia, Pa, USA.
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.
