Clinical and Economic Characteristics Associated with Inpatient Cases of Non-Acquired Immune Deficiency Syndrome (AIDS)-Defining Malignancies in the United States, 2005-2009

Abstract

Specific Aims: To evaluate disease- and patient-related characteristics, mortality, and charges associated with non-AIDS defining malignancies (NADM) among inpatient settings in the United States from 2005 to 2009. Methods: This retrospective cohort investigation utilized nationally-representative hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (H-CUP) Nationwide Inpatient Sample. Inclusion criteria included adult inpatients ≥18 years with a diagnosis of HIV or AIDS and malignant neoplasms. Multivariate regression analyses were used to assess inpatient mortality and charges. Main Results: Overall, 104,488 were included. Average age associated with each case was 46.9 years (±10.66), with 21.9% cases being female (n=22,868). The mean length of stay was 8.6 days (±10.5) and inpatient mortality occurred in 7.7% of cases (n=8,035). The mean number of procedures performed was 2.3 (±2.5) and the mean number of diagnoses on record was 9.5 (±4.4). Charges for each episode of care averaged $59,483 (±85,748), summing to a national bill of $6.14 billion (2011 dollars) over the five-year course. A higher number of cases were associated with teaching hospitals (74.1%), the south (42%), large metropolitan areas (75.1%), median household income in the 0-25th percentile (41.2%), and Medicaid payers (34.3%). Increased mortality was associated with increased age, increased number of diagnoses and procedures, and the comorbidities of anemia, coagulopathy, lymphoma, and fluid and electrolyte disorders. Conclusions: This investigation of NADMs suggest a considerable clinical and economic burden of illness, summing to a 7.7% inpatient death rate and $1.3 billion in charges per year.