Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Jan;19(1):7-17.
doi: 10.1111/hiv.12531. Epub 2017 Jul 11.

Insurance status and mortality among patients with AIDS

A W Jabs  1 , D A Jabs  1   2   3 , M L Van Natta  1 , F J Palella  4 , C L Meinert  1 ; Studies of the Ocular Complications of AIDS Research Group
Affiliations
Observational Study

Insurance status and mortality among patients with AIDS

A W Jabs et al. HIV Med. 2018 Jan.

Abstract

Objectives: The aim of the study was to evaluate risk factors for mortality, including health care insurance status, among patients with AIDS in the era of modern combination antiretroviral therapy (cART).

Methods: This study was part of the prospective, multicentre, observational Longitudinal Study of the Ocular Complications of AIDS (LSOCA). Patients were classified as having private health care insurance, Medicare, Medicaid, or no insurance. Hazard ratios (HRs) for death were calculated using proportional hazards regression models and staggered entries, anchored to the AIDS diagnosis date.

Results: Among 2363 participants with AIDS, 97% were treated with cART. At enrolment, 31% of participants had private insurance, 29% had Medicare, 24% had Medicaid, and 16% were uninsured. Noninfectious, age-related diseases, such as hypertension, diabetes, and renal disease, were more frequent among persons with Medicare than among those with private insurance. Compared with those who were privately insured, mortality was greater among participants with Medicare [adjusted HR (HRadj ) 1.35; 95% confidence interval (CI) 1.08-1.67; P = 0.008]. Among participants with a suppressed HIV viral load, compared with those who were privately insured, HRadj values for mortality were 1.93 (95% CI 1.08-3.44; P = 0.02) for those with Medicare and 2.09 (95% CI 1.02-4.27; P = 0.04) for those with Medicaid. Mortality among initially uninsured participants was not significantly different from that for privately insured participants, but these participants typically obtained ART and insurance during follow-up. Compared with privately insured participants, time-updated HRadj values for mortality were 1.34 (95% CI 1.05-1.70; P = 0.02) for those with Medicare, 1.34 (95% CI 1.01-1.80; P = 0.05) for those with Medicaid, and 1.35 (95% CI 0.97-1.88; P = 0.05) for those who were uninsured.

Conclusions: In persons with AIDS, compared with those with private insurance, those with public insurance had increased mortality, possibly as a result of a greater burden of noninfectious, age-related diseases.

Keywords: AIDS; health insurance; mortality.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: Alexandra W. Jabs: none; Douglas A. Jabs: none; Mark L. Van Natta: none; Frank J. Palella: consultant and/or on the speakers’ bureau for Gilead Sciences, Janssen Pharmaceutical, Merck and Co, and Bristol Myers Squibb; Curtis L. Meinert: none.

Figures

Figure 1
Figure 1
See this image and copyright information in PMC

References

    1. Palella FJ, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med. 1998;338(13):853–60. - PubMed
    1. Murphy EL, Collier AC, Kalish LA, et al. Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease. Ann Intern Med. 2001;135(1):17–26. - PubMed
    1. Egger M, May M, Chene G, et al. Prognosis of HIV-1-infected patients stating highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet. 2002;360(9327):119–29. - PubMed
    1. Hessol NA, Kalinowski A, Benning L, et al. Mortality among participants in the Multicenter AIDS Cohort Study and the Women’s Interagency HIV Study. Clin Infect Dis. 2007;44(2):287–94. - PubMed
    1. Braithwaite RS, Roberts MS, Chang CC, et al. Influence of alternative thresholds for initiating HIV treatment on quality-adjusted life expectancy. Ann Intern Med. 2008;148(3):178–85. - PMC - PubMed

Publication types