Hospital Readmissions Among Persons With Human Immunodeficiency Virus in the United States and Canada, 2005–2018: A Collaboration of Cohort Studies
Authors: Davy-Mendez Thibaut , Napravnik Sonia , Hogan Brenna C , Eron Joseph J , Gebo Kelly A , Althoff Keri N , Moore Richard D , Silverberg Michael J , Horberg Michael A , Gill M John , Rebeiro Peter F , Karris Maile Y , Klein Marina B , Kitahata Mari M , Crane Heidi M , Nijhawan Ank , McGinnis Kathleen A , Thorne Jennifer E , Lima Viviane D , Bosch Ronald J , Colasanti Jonathan A , Rabkin Charles S , Lang Raynell , Berry Stephen A ,   for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International epidemiology Databases to Evaluate AIDS (IeDEA), Benson Constance A , Bosch Ronald J , Kirk Gregory D , Greenberg Alan E , Castel Amanda D , Monroe Anne K , Marconi Vincent , Colasanti Jonathan , Mayer Kenneth H , Grasso Chris , Hogg Robert S , Lima Viviane D , Montaner Julio S G , Salters Kate , Buchacz Kate , Li Jun , Gebo Kelly A , Moore Richard D , Moore Richard D , Jacobson Jeffrey , Horberg Michael A , Silverberg Michael J , Thorne Jennifer E , Brown Todd , Tien Phyllis , D'Souza Gypsyamber , Smith Graham , Loutfy Mona , Gupta Meenakshi , Klein Marina B , Rabkin Charles , Kroch Abigail , Burchell Ann , Betts Adrian , Lindsay Joanne , Nijhawan Ank , Mayor Angel M , Gill M John , Martin Jeffrey N , Deeks Steven G , Li Jun , Brooks John T , Saag Michael S , Mugavero Michael J , Burkholder Greer , Bamford Laura , Karris Maile , Eron Joseph J , Napravnik Sonia , Kitahata Mari M , Crane Heidi M , Sterling Timothy R , Haas David , Rebeiro Peter , Turner Megan , McGinnis Kathleen , Justice Amy , Gange Stephen J , Lee Jennifer S , Hogan Brenna , Humes Elizabeth , Lang Raynell , Coburn Sally , Gerace Lucas , Stewart Cameron 
Published: September 2023

Abstract

Background
Hospital readmission trends for persons with human immunodeficiency virus (PWH) in North America in the context of policy changes, improved antiretroviral therapy (ART), and aging are not well-known. We examined readmissions during 2005–2018 among adult PWH in NA-ACCORD.

Methods
Linear risk regression estimated calendar trends in 30-day readmissions, adjusted for demographics, CD4 count, AIDS history, virologic suppression (&lt;400 copies/mL), and cohort.

Results
We examined 20 189 hospitalizations among 8823 PWH (73% cisgender men, 38% White, 38% Black). PWH hospitalized in 2018 versus 2005 had higher median age (54 vs 44 years), CD4 count (469 vs 274 cells/μL), and virologic suppression (83% vs 49%). Unadjusted 30-day readmissions decreased from 20.1% (95% confidence interval [CI], 17.9%–22.3%) in 2005 to 16.3% (95% CI, 14.1%–18.5%) in 2018. Absolute annual trends were −0.34% (95% CI, −.48% to −.19%) in unadjusted and −0.19% (95% CI, −.35% to −.02%) in adjusted analyses. By index hospitalization reason, there were significant adjusted decreases only for cardiovascular and psychiatric hospitalizations. Readmission reason was most frequently in the same diagnostic category as the index hospitalization.

Conclusions
Readmissions decreased over 2005–2018 but remained higher than the general population's. Significant decreases after adjusting for CD4 count and virologic suppression suggest that factors alongside improved ART contributed to lower readmissions. Efforts are needed to further prevent readmissions in PWH.