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Alcohol problems and health care services use in human immunodeficiency virus (HIV)-infected and HIV-uninfected veterans.

Kraemer KL, McGinnis KA, Skanderson M, Cook R, Gordon A, Conigliaro J, Shen Y, Fiellin DA, Justice AC. Alcohol problems and health care services use in human immunodeficiency virus (HIV)-infected and HIV-uninfected veterans. Medical care. 2006 Aug 1; 44(8 Suppl 2):S44-51.

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Abstract:

BACKGROUND: Although alcohol problems are common in human immunodeficiency virus (HIV)-infected patients, their impact on health care services use in HIV-infected patients is not well understood. OBJECTIVE: We sought to examine the association between alcohol problems and health care services use in HIV-infected and HIV-uninfected patients. DESIGN, SETTING, AND SUBJECTS: We undertook a prospective analysis of 16,048 HIV-infected veterans and 32,096 age-, race-, gender-, and region-matched HIV-uninfected controls identified through the national Veterans Affairs electronic administrative medical record database. We identified subjects with alcohol problems using ICD-9-CM codes for alcohol diagnoses and/or alcohol-related complications. MAIN OUTCOME MEASURES: We measured outpatient visits, emergency department visits, and inpatient hospitalizations over 12 months of follow-up. RESULTS: In adjusted analyses, HIV-infected veterans with alcohol problems were significantly more likely than HIV-uninfected veterans without alcohol problems to have at least 1 outpatient visit and at least 1 inpatient hospitalization and, among those with any health services use, to have significantly greater rates for outpatient visits (Incidence rate ratio [IRR] 2.17; 95% confidence interval [CI] 2.06-2.28; P < 0.001), emergency department visits (IRR 1.46; 95% CI 1.35-1.58; P < 0.001), and inpatient hospitalizations (IRR 1.46; 95% CI 1.30-1.64; P < 0.001). The incidence rates for outpatient visits, mental health visits, emergency department visits, and inpatient hospitalizations were significantly higher in HIV-infected veterans with alcohol problems than in HIV-infected veterans without alcohol problems. We did not find a consistent interaction effect between alcohol problems and HIV status. CONCLUSION: Alcohol problems are associated with greater outpatient, emergency department, and inpatient health care utilization in HIV-infected and HIV-uninfected veterans. However, alcohol does not appear to have a stronger effect on health services use in HIV-infected veterans compared with HIV-uninfected veterans.





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