1906. Hospitalization Rates among Persons with HIV Who Gained Medicaid or Private Insurance in 2014
Session: Poster Abstract Session: Clinical Practice Issues: HIV, Sepsis, QI, Diagnosis
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • ID week 2018 poster ChowJY3.pdf (815.7 kB)
  • Background: The Ryan White Program (RWP), which provides safety net outpatient healthcare coverage to thousands of low-income persons with HIV (PWH), does not pay for inpatient care. Many PWH who relied on RWP transitioned to either Medicaid or private insurance (private) with the Affordable Care Act in 2014. It is unknown whether such transitions affected hospitalization rates.

    Methods: We included patients from 3 HIV Research Network sites (2 in Medicaid expansion states, 1 in a non-expansion state) who relied solely on RWP in 2013. Patients either stayed in RWP through 2015, or changed to Medicaid or private in 2014. 2015 hospitalization rate ratios were modeled using negative binomial regression, adjusting for demographics, CD4 count, HIV viral load (VL), clinic site, and number of 2013 hospitalizations.

    Results: Our sample of 1,634 patients was 73% male, 46% Black, 36% Hispanic; median age was 45 years (IQR 37,52) and median CD4 count 526 cells/uL (356, 716); 85% had a VL ≤400 copies/mL. 95 patients were hospitalized in 2015. Unadjusted hospitalization rates (per 100 person years) were 8.4, 21.3, and 7.4 in 2013 and 6.3, 20.2, and 3.7 in 2015 for those who remained in RWP, switched to Medicaid, or switched to private, respectively.

    Switching to Medicaid or private was not associated with 2015 hospitalization rates (IRR 1.26 (95%CI 0.71-2.23) and 0.48 (0.18-1.28), table). Older age, CD4 <200, VL >400, and number of 2013 hospitalizations were associated with higher rates.

    Conclusion: Among PWH relying on RWP in 2013, changing to either Medicaid or private insurance was not associated with a change in hospitalization rate. Among PWH, gaining inpatient coverage does not appear to increase inpatient utilization.

    Incidence Rate Ratios for Hospitalization, 2015 (n=1634)

    Characteristic

    IRR

    95% CI

    Insurance in 2015

    RWP

    -

    Private

    0.48

    0.18-1.28

    Medicaid

    1.26

    0.71-2.23

    Gender

    Female

    -

    Male or transgender

    0.86

    0.47-1.58

    Race

    White or other

    -

    Black

    1.19

    0.62-2.27

    Hispanic

    0.83

    0.40-1.72

    Age

    18-34

    -

    35-44

    0.91

    0.45-1.83

    45-54

    1.51

    0.75-3.07

    55-64

    2.18

    1.08-4.41

    Risk factor

    Heterosexual or Other

    -

    IVDU

    1.77

    0.68-4.60

    MSM

    1.68

    0.92-3.05

    CD4 count

    <200

    5.0

    2.60-9.61

    200-499

    1.26

    0.71-2.22

    ≥500

    -

    VL ≤400

    0.55

    0.32-0.94

    # of hospitalizations, 2013

    1.97

    1.44-2.68

    Jeremy Chow, MD, MS1, Ank Nijhawan, MD, MPH, MSCS1, Julia Raifman, ScD2, Kelly Gebo, MD, MPH, FIDSA3, Richard Moore, MD, MHS, FIDSA4, Stephen Berry, MD, PhD5 and HIV Research Network, (1)Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, TX, (2)Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, (3)John Hopkins University School of Medicine, Baltimore, MD, (4)Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, (5)Johns Hopkins University School of Medicine, Baltimore, MD

    Disclosures:

    J. Chow, None

    A. Nijhawan, Gilead: Consultant , Research support .

    J. Raifman, None

    K. Gebo, None

    R. Moore, None

    S. Berry, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.