Health Care Use among Medicare Beneficiaries with HIV and Depression during the COVID-19 Pandemic—United States, 2020
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data and Study Outcomes
2.2. Study Covariates
2.3. Analysis
3. Results
3.1. Descriptive Characteristics
3.2. Health Care Services Utilization
3.3. Association between Health Care Services Utilization and MB Characteristics and Claims
3.4. Association of Health Care Services Utilization and MB Claims, by Race/Ethnicity
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Disclaimer
References
- Bastani, P.; Mohammadpour, M.; Samadbeik, M.; Bastan, M.; Rossi-Fedele, G.; Balasubramanian, M. Factors influencing access and utilization of health services among older people during the COVID-19 pandemic: A scoping review. Arch. Public Health 2021, 79, 190. [Google Scholar] [CrossRef] [PubMed]
- Cifaldi, M. Factors affecting health services utilization in the Medicare population: Would providing prescription drug coverage to Medicare recipients affect their use of health care resources? In Investing in Health: The Social and Economic Benefits of Health Care Innovation; Research in Human Capital and Development; Farquhar, I., Summers, K., Sorkin, A., Eds.; Emerald Group Publishing Limited: Bingley, UK, 2001; Volume 14, pp. 119–141. [Google Scholar]
- McFall, A.M.; Menezes, N.P.; Srikrishnan, A.K.; Solomon, S.S.; Anand, S.; Baishya, J.J.; Lucas, G.M.; Celentano, D.D.; Mehta, S.H. Impact of the COVID-19 pandemic on HIV prevention and care services among key populations across 15 cities in India: A longitudinal assessment of clinic-based data. J. Int. AIDS Soc. 2022, 25, e25960. [Google Scholar] [CrossRef]
- Norwood, J.; Kheshti, A.; Shepherd, B.E.; Rebeiro, P.F.; Ahonkhai, A.; Kelly, S.; Wanjalla, C. The impact of COVID-19 on the HIV care continuum in a large urban southern clinic. AIDS Behav. 2022, 26, 2825–2829. [Google Scholar] [CrossRef] [PubMed]
- Centers for Disease Control and Prevention. Diagnoses of HIV Infection in the United States and Dependent Areas. 2020; HIV Surveillance Report. 2021, Volume 33. Available online: https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-33/index.html (accessed on 7 November 2022).
- Mirzaei, H.; McFarland, W.; Karamouzian, M.; Sharif, H. COVID-19 among people living with HIV: A systematic review. AIDS Behav. 2021, 25, 85–92. [Google Scholar] [CrossRef]
- National Institute of Mental Health. HIV and AIDS and Mental Health. National Institutes of Health, National Institute of Mental Health. Available online: https://www.nimh.nih.gov/health/topics/hiv-aids#:~:text=People%20living%20with%20HIV%2FAIDS,affect%20a%20person%27s%20mental%20health (accessed on 29 August 2022).
- Parisi, C.E.; Varma, D.S.; Wang, Y.; Vaddiparti, K.; Ibañez, G.E.; Cruz, L.; Cook, R.L. Changes in mental health among people with HIV during the COVID-19 pandemic: Qualitative and quantitative perspectives. AIDS Behav. 2022, 26, 1980–1991. [Google Scholar] [CrossRef]
- Ettman, C.K.; Abdalla, S.M.; Cohen, G.H.; Sampson, L.; Vivier, P.M.; Galea, S. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Netw. Open 2020, 3, e2019686. [Google Scholar] [CrossRef] [PubMed]
- Centers for Disease Control and Prevention. Anxiety and Depression—Household Pulse Survey. Centers for Disease Control and Prevention, National Center for Health Statistics. Available online: https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm (accessed on 7 November 2022).
- Javanbakht, M.; Rosen, A.; Ragsdale, A.; Richter, E.I.; Shoptaw, S.; Gorbach, P.M. Interruptions in mental health care, cannabis use, depression, and anxiety during the COVID-19 pandemic: Findings from a cohort of HIV-positive and HIV-negative MSM in Los Angeles, California. J. Urban Health 2022, 99, 305–315. [Google Scholar] [CrossRef]
- Kuman Tunçel, O.; Pullukçu, H.; Erdem, H.A.; Kurtaran, B.; Taşbakan, S.E.; Taşbakan, M. COVID-19-related anxiety in people living with HIV: An online cross-sectional study. Turk. J. Med. Sci. 2020, 50, 1792–1800. [Google Scholar] [CrossRef]
- Chang, M.; Moonesinghe, R.; Truman, B.I. COVID-19 hospitalization by race and ethnicity: Association with chronic conditions among Medicare beneficiaries, January 1–September 30, 2020. J. Racial Ethn. Health Disparities 2022, 9, 325–334. [Google Scholar] [CrossRef]
- Chronic Conditions Data Warehouse: Condition Categories. Centers for Medicare and Medicaid Services. Available online: https://www.ccwdata.org/web/guest/condition-categories (accessed on 28 August 2022).
- Research Data Assistance Center. MEDPAR Short Stay, Long Stay, SNF Indicator Code. Available online: https://resdac.org/cms-data/variables/medpar-short-staylong-staysnf-indicator-code (accessed on 28 August 2022).
- Research Data Assistance Center. Provider Number. Available online: https://resdac.org/cms-data/variables/provider-number (accessed on 28 August 2022).
- Ingram, D.D.; Franco, S.J. 2013 NCHS Urban–Rural Classification Scheme for Counties; Vital Health Statistics, Series 2, Number 166; Centers for Disease Control and Prevention: Atlanta, GA, USA, 2014; pp. 1–73. [Google Scholar]
- Grand, M.; Bia, D.; Diaz, A. Cardiovascular risk assessment in people living with HIV: A systematic review and meta-analysis of real-life data. Curr. HIV Res. 2020, 18, 5–18. [Google Scholar]
- Deeks, S.G.; Overbaugh, J.; Phillips, A.; Buchbinder, S. HIV infection. Nat. Rev. Dis. Prim. 2015, 1, 15035. [Google Scholar] [CrossRef] [PubMed]
- Chronic Conditions Data Warehouse: Data Dictionaries. Centers for Medicare and Medicaid Services. 2020. Available online: https://www.ccwdata.org/web/guest/data-dictionaries (accessed on 28 August 2022).
- May, D.; Fullilove, R. Depression, HIV, and COVID-19: A deadly trifecta. Public Health Rep. 2022, 137, 420–424. [Google Scholar] [CrossRef]
- Brouillette, M.; Koski, L.; Scott, S.; Austin-Keiller, A.; Fellows, L.K.; Mayo, N.E. Factors influencing psychological distress during the COVID-19 pandemic in people aging with HIV. AIDS Res, Hum. Retrovir. 2022, 38, 421–430. [Google Scholar] [CrossRef] [PubMed]
- Chang, M.H.; Moonesinghe, R.; Truman, B.I. Racial and ethnic differences in COVID-19 hospitalizations by metropolitan status among Medicare beneficiaries, 1 January–31 December 2020. J. Public Health 2022, 44, e211–e220. [Google Scholar] [CrossRef] [PubMed]
- Ochieng, N.; Cubanski, J.; Neuman, T.; Artiga, S.; Damico, A. Racial and Ethnic Health Inequities and Medicare. Kaiser Family Foundation: Washington, DC, USA, 2021. Available online: https://files.kff.org/attachment/Report-Racial-and-Ethnic-Health-Inequities-and-Medicare.pdf (accessed on 2 September 2022).
- Bertakis, K.D.; Azari, R.; Helms, L.J.; Callahan, E.J.; Robbins, J.A. Gender differences in the utilization of health care services. J. Fam. Pract. 2000, 49, 147–152. [Google Scholar]
- HHS Announces Nearly $44 Million to Strengthen Mental Health and Substance Use Services for Populations at Risk for or Living with HIV/AIDS. U.S. Department of Health and Human Services. 18 March 2022. Available online: https://www.hhs.gov/about/news/2022/03/18/hhs-announces-nearly-44-million-strengthen-mental-health-substance-use-services-populations-risk-living-hiv-aids.html (accessed on 12 September 2022).
- Guidance for COVID-19 and People with HIV. Clinicalinfo.HIV.gov website. Available online: https://clinicalinfo.hiv.gov/en/guidelines/guidance-covid-19-and-people-hiv/guidance-covid-19-and-people-hiv (accessed on 26 January 2023).
- Chang, M.H.; Moonesinghe, R.; Truman, B.I. Telehealth availability and usage among Medicare beneficiaries during the COVID-19 pandemic, October and November 2020. J. Public Health Manag. Pract. 2022, 28, 77–85. [Google Scholar] [CrossRef]
- Centers for Medicare and Medicaid Services. Medicare Telemedicine Health Care Provider Fact Sheet. Available online: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet (accessed on 12 September 2022).
- Lopez, L., III; Hart, L.H., III; Katz, M.H. Racial and ethnic health disparities related to COVID-19. JAMA 2021, 325, 719–720. [Google Scholar] [CrossRef]
- Mackey, K.; Ayers, C.K.; Kondo, K.K.; Saha, S.; Advani, S.M.; Young, S.; Spencer, H.; Rusek, M.; Anderson, J.; Veazie, S.; et al. Racial and ethnic disparities in COVID-19-related infections, hospitalizations, and deaths: A systematic review. Ann. Intern. Med. 2021, 174, 362–373. [Google Scholar] [CrossRef]
- Prabhu, S.; Poongulali, S.; Kumarasamy, N. Impact of COVID-19 on people living with HIV: A review. J. Virus Erad. 2020, 6, 100019. [Google Scholar] [CrossRef]
- Sarkar, S.; Khanna, P.; Singh, A.K. Impact of COVID-19 in patients with concurrent co-infections: A systematic review and meta-analyses. J. Med. Virol. 2021, 93, 2385–2395. [Google Scholar] [CrossRef]
- Health Equity in Healthy People 2030. Healthy People 2030. Available online: https://health.gov/healthypeople/priority-areas/health-equity-healthy-people-2030 (accessed on 12 September 2022).
- Increase Linkage to HIV Medical Care—HIV-04. Healthy People 2030. Available online: https://health.gov/healthypeople/objectives-and-data/browse-objectives/sexually-transmitted-infections/increase-linkage-hiv-medical-care-hiv-04 (accessed on 12 September 2022).
- Wagner, G.J.; Wagner, Z.; Gizaw, M.; Saya, U.; MacCarthy, S.; Mukasa, B.; Wabukala, P.; Linnemayr, S. Increased depression during COVID-19 lockdown associated with food insecurity and antiretroviral non-adherence among people living with HIV in Uganda. AIDS Behav. 2022, 26, 2182–2190. [Google Scholar] [CrossRef] [PubMed]
- Integration of Mental Health and HIV Interventions: Key Considerations. Geneva: Joint United Nations Programme on HIV/AIDS and the World Health Organization. 2022. Available online: https://www.unaids.org/sites/default/files/media_asset/integration-mental-health-hiv-interventions_en.pdf (accessed on 7 November 2022).
- Assefa, Y.; Gilks, C.F. Ending the epidemic of HIV/AIDS by 2030: Will there be an endgame to HIV, or an endemic HIV requiring an integrated health systems response in many countries? Int. J. Infect. Dis. 2020, 100, 273–277. [Google Scholar] [CrossRef] [PubMed]
- Centers for Disease Control and Prevention. About Ending the HIV Epidemic in the U.S. Initiative. Centers for Disease Control and Prevention. Available online: https://www.cdc.gov/endhiv/about.html (accessed on 7 November 2022).
- McGinnis, B.; Kauffman, Y.; Olson, K.L.; Witt, D.M.; Raebel, M.A. Interventions aimed at improving performance on medication adherence metrics. Int. J. Clin. Pharm. 2014, 36, 20–25. [Google Scholar] [CrossRef] [PubMed]
Characteristics a | HIV and Depression | HIV Only | Depression Only | Neither HIV nor Depression | Total |
---|---|---|---|---|---|
Total n (%) | 46,523 (0.11) | 74,389 (0.18) | 6,542,197 (16.18) | 33.8 M (83.53) | 40.4 M (100) |
Demographic and Social | |||||
Age group, yrs | |||||
<65 | 68.59 | 54.64 | 23.29 | 10.95 | 13.09 |
65–74 | 25.31 | 36.49 | 37.63 | 53.19 | 50.61 |
75–84 | 5.11 | 7.77 | 24.84 | 24.70 | 24.67 |
≥85 | 0.99 | 1.10 | 14.24 | 11.17 | 11.64 |
Mean | 58.09 | 60.91 | 70.64 | 71.88 | 71.64 |
Sex | |||||
Male | 70.94 | 76.81 | 33.57 | 49.81 | 47.25 |
Female | 29.06 | 23.19 | 66.43 | 50.19 | 52.75 |
Race/ethnicity | |||||
Non-Hispanic White | 49.52 | 40.67 | 82.38 | 75.87 | 76.83 |
Black (or African American) | 34.87 | 42.95 | 7.59 | 9.31 | 9.12 |
Hispanic | 12.24 | 12.10 | 5.78 | 7.40 | 7.15 |
Asian/Pacific Islander | 0.90 | 1.32 | 1.57 | 3.66 | 3.31 |
American Indian/Alaska Native | 0.62 | 0.63 | 0.61 | 0.53 | 0.54 |
Others/Unknown | 1.85 | 2.32 | 2.08 | 3.24 | 3.05 |
Medicare status code b | |||||
Aged without ESRD | 27.00 | 41.20 | 67.85 | 83.59 | 80.91 |
Aged with ESRD | 1.12 | 1.23 | 0.74 | 0.37 | 0.44 |
Disabled without ESRD | 61.27 | 47.53 | 21.50 | 9.93 | 11.92 |
Disabled with ESRD | 2.78 | 3.22 | 0.59 | 0.28 | 0.34 |
ESRD only | 0.69 | 1.18 | 0.18 | 0.22 | 0.21 |
Other | 7.14 | 5.65 | 9.14 | 5.61 | 6.18 |
Geographic | |||||
U.S. Census region | |||||
Northeast | 22.95 | 22.31 | 18.47 | 17.85 | 17.96 |
Midwest | 14.19 | 12.30 | 23.41 | 21.31 | 21.62 |
South | 43.03 | 46.21 | 40.03 | 37.59 | 38.01 |
West | 19.64 | 18.71 | 17.95 | 21.12 | 20.60 |
U.S. territories | 0.19 | 0.46 | 0.14 | 2.13 | 1.80 |
Metropolitan areas | |||||
Metropolitan | 91.07 | 90.68 | 79.28 | 80.22 | 80.09 |
Nonmetropolitan | 8.93 | 9.32 | 20.72 | 19.78 | 19.91 |
Clinical | |||||
Comorbidities | |||||
0 | 4.26 | 14.35 | 3.97 | 36.84 | 31.45 |
1–3 | 42.64 | 54.79 | 43.38 | 42.07 | 42.30 |
4–5 | 26.56 | 19.71 | 28.06 | 14.58 | 16.79 |
≥6 | 26.54 | 11,15 | 25.59 | 6.51 | 9.46 |
End-stage renal disease | |||||
Yes | 5.58 | 6.25 | 1.96 | 1.03 | 1.20 |
No | 94.42 | 93.75 | 98.04 | 98.97 | 98.80 |
Hospital outpatient emergency room visits | |||||
≥1 | 53.32 | 33.69 | 46.03 | 18.14 | 22.72 |
0 | 46.68 | 66.31 | 53.97 | 81.86 | 77.28 |
Hospitalizations | |||||
Short-stay hospitalization c | |||||
Yes (≥1) | 34.51 | 18.06 | 30.04 | 10.75 | 13.91 |
No (0) | 65.49 | 81.94 | 69.96 | 89.25 | 86.09 |
Long-stay hospitalization d | |||||
Yes (≥1) | 5.29 | 0.93 | 4.04 | 0.76 | 1.30 |
No (0) | 94.71 | 99.07 | 95.96 | 99.24 | 98.70 |
Average length of stay e | |||||
0 days | 64.08 | 81.70 | 68.76 | 88.98 | 85.67 |
1 day | 2.96 | 2.27 | 3.08 | 1.66 | 1.89 |
2–5 days | 15.78 | 8.64 | 14.85 | 5.53 | 7.05 |
6–10 days | 8.82 | 4.05 | 7.43 | 2.21 | 3.07 |
≥11 days | 8.36 | 3.33 | 5.88 | 1.62 | 2.32 |
Outpatient diagnostic services | |||||
Yes (≥1) | 98.12 | 96.09 | 98.19 | 74.73 | 78.59 |
No (0) | 1.88 | 3.91 | 1.81 | 25.27 | 21.41 |
Drug treatment services | |||||
Yes (≥1) | 90.95 | 85.57 | 77.28 | 53.10 | 57.11 |
No (0) | 9.05 | 14.43 | 22.72 | 46.90 | 42.89 |
Outpatient procedure services | |||||
Yes (≥1) | 98.12 | 96.09 | 98.19 | 74.73 | 78.59 |
No (0) | 1.88 | 3.91 | 1.81 | 25.27 | 21.41 |
Characteristics | Hospitalization (Short-Stay) b | Hospitalization (Long-Stay) c,d | Outpatient Diagnostic Services d | Drug Treatment Services d | Outpatient Procedure Services d |
---|---|---|---|---|---|
n (%) | n (%) | n (%) | n (%) | n (%) | |
Demographic | |||||
Age group, yrs | |||||
<65 | 9597 (32.88) | 1698 (5.82) | 28,628 (98.09) | 27,076 (92.78) | 28,628 (68.57) |
65–74 | 3853 (35.78) | 431 (4.00) | 10,581 (98.25) | 9439 (87.64) | 10,581 (98.25) |
75–84 | 983 (45.22) | 94 (4.32) | 2127 (97.84) | 1839 (84.59) | 2126 (97.79) |
≥85 | 251 (59.34) | NR | 417 (98.58) | 348 (82.27) | 417 (98.58) |
Sex | |||||
Male | 10,098 (33.45) | 1574 (5.21) | 29,565 (97.94) | 27,182 (90.05) | 29,565 (97.94) |
Female | 4586 (37.09) | 675 (5.46) | 12,188 (98.57) | 11,520 (93.17) | 12,187 (98.56) |
Race/ethnicity | |||||
Non-Hispanic White | 6503 (30.86) | 1075 (5.10) | 20,716 (98.32) | 18,877 (89.59) | 20,716 (98.32) |
Black (or African American) | 6031 (40.65) | 892 (6.01) | 14,529 (97.92) | 13,720 (92.47) | 14,529 (97.92) |
Hispanic | 1648 (31.64) | 205 (3.94) | 5097 (97.87) | 4837 (92.88) | 5096 (97.85) |
Asian/Pacific Islander | 113 (29.50) | NR | 377 (98.43) | 359 (93.73) | 377 (98.43) |
American Indian/Alaska Native | 107 (40.38) | NR | 265 (100.0) | 238 (89.81) | 265 (100.0) |
Others/Unknown | 282 (35.88) | 45 (5.73) | 769 (97.84) | 671 (85.37) | 769 (97.84) |
Medicare status code a | |||||
Aged without ESRD | 3696 (32.17) | 404 (3.52) | 11,327 (98.60) | 10,050 (87.48) | 11,326 (98.59) |
Aged with ESRD | 360 (75.47) | NR | 471 (98.74) | 425 (89.10) | 471 (98.74) |
Disabled without ESRD | 7381 (28.31) | 1460 (5.60) | 25,650 (98.39) | 24,316 (93.28) | 25,650 (98.39) |
Disabled with ESRD | 873 (73.67) | 66 (5.57) | 1181 (99.66) | 1106 (93.33) | 1181 (99.66) |
ESRD only | 214 (73.04) | NR | 289 (98.63) | 251 (85.67) | 289 (98.63) |
Other | 2160 (71.10) | 273 (8.99) | 2834 (93.29) | 2554 (84.07) | 2834 (93.29) |
Geographic | |||||
U.S. Census region | |||||
Northeast | 3442 (35.25) | 312 (3.20) | 9554 (97.85) | 9056 (92.75) | 9553 (97.84) |
Midwest | 2112 (34.97) | 302 (5.00) | 5943 (98.41) | 5577 (92.35) | 5943 (98.41) |
South | 6612 (36.11) | 1256 (6.86) | 17,959 (98.08) | 16,400 (89.57) | 17,959 (98.08) |
West | 2486 (29.75) | 366 (4.38) | 8239 (98.60) | 7651 (91.56) | 8239 (98.60) |
U.S. territories | 31 (38.75) | NR | 56 (70.00) | NR | 56 (70.0) |
Metropolitan areas | |||||
Metropolitan | 13,449 (34.79) | 1990 (5.15) | 37,941 (98.15) | 35,187 (91.03) | 37,940 (98.15) |
Nonmetropolitan | 1188 (31.35) | 244 (6.44) | 3730 (98.42) | 3480 (91.82) | 3730 (98.42) |
Clinical | |||||
Comorbidities | |||||
0 | 147 (8.11) | NR | 1737 (95.86) | 1628 (89.85) | 1737 (95.86) |
1–3 | 3256 (17.94) | 547 (3.01) | 17,720 (97.66) | 16,498 (90.92) | 17,720 (97.66) |
4–5 | 3990 (35.30) | 668 (5.91) | 11,114 (98.34) | 10,281 (90.97) | 11,114 (98.34) |
≥6 | 7291 (64.57) | 1018 (9.02) | 11,182 (99.03) | 10,295 (91.17) | 11,181 (99.02) |
End-stage renal disease | |||||
Yes | 1818 (76.55) | 156 (6.57) | 2353 (99.07) | 2135 (89.89) | 2353 (99.07) |
No | 12,866 (32.02) | 2093 (5.21) | 39,400 (98.07) | 36,567 (91.02) | 39,399 (98.07) |
Hospital outpatient emergency room visits (No. per year) | |||||
≥1 | 13,646 (60.14) | 2037 (8.98) | 22,528 (99.29) | 20,853 (91.90) | 22,528 (99.29) |
0 | 1038 (5.23) | 212 (1.07) | 19,225 (96.80) | 17,849 (89.87) | 19,224 (96.79) |
Characteristics | Hospitalization (Short-Stay) a | Hospitalization (Long-Stay) b | Outpatient Diagnostic Services | Drug Treatment Services | Outpatient Procedure Services |
---|---|---|---|---|---|
aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | |
Demographic and social | |||||
Age group, yrs | |||||
≥85 | 1.8 (1.8–1.8) * | 0.9 (0.9–0.9) * | 0.8 (0.8–0.8) * | 0.7 (0.7–0.7) * | 0.8 (0.8–0.8) * |
75–84 | 1.4 (1.4–1.4) * | 0.8 (0.8–0.8) * | 1.2 (1.2–1.2) * | 0.8 (0.8–0.8) * | 1.2 (1.2–1.2) * |
65–74 | 1.1 (1.1–1.1) * | 0.7 (0.7–0.7) * | 0.9 (0.9–0.9) * | 0.7 (0.7–0.7) * | 0.9 (0.9–0.9) * |
<65 | Ref | Ref | Ref | Ref | Ref |
Sex | |||||
Male | 1.2 (1.2–1.2) * | 1.2 (1.2–1.2) * | 0.6 (0.6–0.6) * | 0.7 (0.7–0.7) * | 0.6 (0.6–0.6) * |
Female | Ref | Ref | Ref | Ref | Ref |
Race/ethnicity | |||||
Black (or African American) | 1.1 (1.1–1.1) * | 1.1 (1.0–1.1) * | 0.5 (0.5–0.5) * | 0.8 (0.8–0.8) * | 0.5 (0.5–0.5) * |
Hispanic | 1.0 (1.0–1.0) * | 1.0 (1.0–1.0) * | 0.5 (0.5–0.5) * | 1.0 (1.0–1.0) * | 0.5 (0.5–0.5) * |
Asian/Pacific Islander | 0.8 (0.8–0.8) * | 0.7 (0.6–0.7) * | 0.6 (0.6–0.6) * | 1.2 (1.2–1.2) * | 0.6 (0.6–0.6) * |
American Indian/Alaska Native | 1.4 (1.4–1.4) * | 1.4 (1.4–1.4) * | 0.7 (0.7–0.7) * | 0.7 (0.6–0.7) * | 0.7 (0.7–0.7) * |
Others/Unknown | 0.9 (0.9–0.9) * | 0.9 (0.9–1.0) * | 1.0 (1.0–1.0) * | 1.1 (1.1–1.1) * | 1.0 (1.0–1.0) * |
Non-Hispanic White | Ref | Ref | Ref | Ref | Ref |
Geographic | |||||
U.S. Census region | |||||
Midwest | 1.0 (0.9–1.0) * | 1.4 (1.4–1.4) * | 1.3 (1.3–1.3) * | 0.9 (0.9–0.9) * | 1.3 (1.3–1.7) * |
South | 0.9 (0.9–0.9) * | 1.4 (1.3–1.4) * | 1.2 (1.2–1.2) * | 0.7 (0.7–0.7) * | 1.2 (1.2–1.2) * |
West | 0.8 (0.8–0.8) * | 1.4 (1.4–1.4) * | 1.6 (1.3–2.0) * | 0.8 (0.8–0.8) * | 1.2 (1.2–1.2) * |
U.S. territories | NR | NR | NR | NR | NR |
Northeast | Ref | Ref | Ref | Ref | Ref |
Metropolitan areas | |||||
Nonmetropolitan | 0.8 (0.8–0.8) * | 2.3 (2.3–2.3) * | 1.4 (1.4–1.4) * | 1.2 (1.2– 1.2) * | 1.4 (1.4–1.4) * |
Metropolitan | Ref | Ref | Ref | Ref | Ref |
Clinical | |||||
Comorbidities | |||||
≥6 | 4.4 (4.4–4.4) * | 4.3 (4.2–4.3) * | 41.6 (41.2–42.0) * | 7.5 (7.5–7.5) * | 41.6 (41.2–42.0) * |
4–5 | 1.8 (1.8–1.8) * | 2.5 (2.5–2.5) * | 55.3 (55.0–55.7) * | 7.2 (7.2–7.2) * | 55.3 (55.0–55.6) * |
1–3 | 0.9 (0.9–0.9) * | 1.6 (1.5–1.6) * | 43.8 (43.7–44.0) * | 6.4 (6.3–6.4) * | 43.8 (43.7–44.0) * |
0 | Ref | Ref | Ref | Ref | Ref |
End-stage renal disease | |||||
Yes | 2.9 (2.9–2.9) * | 0.9 (0.9–1.0) * | 0.8 (0.8–0.8) * | 1.1 (1.1–1.1) * | 0.8 (0.8–0.8) * |
No | Ref | Ref | Ref | Ref | Ref |
Hospital outpatient emergency room visits (No. per year) | |||||
≥1 | 16.0 (16.0–16.1) * | 10.2 (10.1–10.3) * | 12.5 (12.4–12.6) * | 1.1 (1.1–1.1) * | 12.5 (12.4–12.6) * |
0 | Ref | Ref | Ref | Ref | Ref |
HIV and depression claims | |||||
HIV and depression | 1.6 (1.5–1.6) * | 2.5 (2.4–2.6) * | 4.4 (3.8–4.5) * | 4.9 (4.7–5.1) * | 4.2 (3.8–4.5) * |
HIV only | 1.0 (1.0–1.1) * | 0.7 (0.7–0.8) * | 7.0 (6.7–7.3) * | 4.4 (4.3–4.5) * | 7.0 (6.7–7.3) * |
Depression only | 1.5 (1.5–1.5) * | 2.2 (2.1–2.2) * | 2.9 (2.9–2.9) * | 1.4 (1.4–1.4) * | 2.9 (2.9–2.9) * |
Neither HIV nor depression | Ref | Ref | Ref | Ref | Ref |
Characteristics | Non-Hispanic White | Non-Hispanic Black | Hispanic |
---|---|---|---|
aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | |
Hospitalization (short-stay) b | |||
HIV and depression claims | |||
HIV and depression | 1.6 (1.5–1.7) * | 1.7 (1.6–1.7) * | 1.5 (1.4–1.6) * |
HIV only | 1.0 (1.1–1.2) * | 1.1 (1.0–1.1) * | 1.0 (1.0–1.1) |
Depression only | 1.5 (1.5–1.5) * | 1.5 (1.5–1.5) * | 1.3 (1.3–1.4) * |
Neither HIV nor depression | Ref | Ref | Ref |
Hospitalization (long-stay) c | |||
HIV and depression claims | |||
HIV and depression | 2.6 (2.5–2.8) * | 2.6 (2.4–2.8) * | 2.1 (1.8–2.4) * |
HIV only | 0.8 (0.7–0.9) * | 0.7 (0.7–0.8) * | 0.7 (0.5–0.9) * |
Depression only | 2.1 (2.1–2.1) * | 2.7 (2.6–2.7) * | 2.4 (2.3–2.5) * |
Neither HIV nor depression | Ref | Ref | Ref |
Outpatient diagnostic services | |||
HIV and depression claims | |||
HIV and depression | 4.0 (3.6–4.5) * | 3.0 (2.6–3.4) * | 5.3 (4.2–6.8) * |
HIV only | 7.0 (6.5–7.5) * | 5.5 (5.2–5.9) * | 7.1 (6.3–8.0) * |
Depression only | 2.9 (2.8–2.9) * | 2.3 (2.3–2.4) * | 3.4 (3.3–3.4) * |
Neither HIV nor depression | Ref | Ref | Ref |
Drug treatment services | |||
HIV and depression claims | |||
HIV and depression | 4.2 (4.0–4.4) * | 5.5 (5.2–5.9) * | 6.1 (5.4–6.9) * |
HIV only | 3.7 (3.6–3.8) * | 4.9 (4.7–5.0) * | 5.9 (5.5–6.4) * |
Depression only | 1.4 (1.4–1.4) * | 1.6 (1.6–1.7) * | 1.7 (1.7–1.7) * |
Neither HIV nor depression | Ref | Ref | Ref |
Outpatient procedure services | |||
HIV and depression claims | |||
HIV and depression | 4.0 (3.6–4.5) * | 3.0 (2.6–3.4) * | 5.3 (4.2–6.7) * |
HIV only | 7.0 (6.5–7.5) * | 5.5 (5.2–5.9) * | 7.1 (6.3–8.0) * |
Depression only | 2.9 (2.8–2.9) * | 2.3 (2.3–2.4) * | 3.4 (3.3–3.4) * |
Neither HIV nor depression | Ref | Ref | Ref |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Chang, M.-H.; Moonesinghe, R.; Truman, B.I. Health Care Use among Medicare Beneficiaries with HIV and Depression during the COVID-19 Pandemic—United States, 2020. Healthcare 2023, 11, 1126. https://doi.org/10.3390/healthcare11081126
Chang M-H, Moonesinghe R, Truman BI. Health Care Use among Medicare Beneficiaries with HIV and Depression during the COVID-19 Pandemic—United States, 2020. Healthcare. 2023; 11(8):1126. https://doi.org/10.3390/healthcare11081126
Chicago/Turabian StyleChang, Man-Huei, Ramal Moonesinghe, and Benedict I Truman. 2023. "Health Care Use among Medicare Beneficiaries with HIV and Depression during the COVID-19 Pandemic—United States, 2020" Healthcare 11, no. 8: 1126. https://doi.org/10.3390/healthcare11081126