225235 Pneumonia and influenza hospitalizations in American seniors: The impact of HIV

Monday, November 8, 2010

Jenerius Aminawung, MD, MPH , Tufts Initiative for the Forcasting and Modeling of Infectious Diseases, Tufts University School of Medicine, Boston
Siobhan M. Mor, BSc(Vet) BVSc PhD , Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
Alfred DeMaria, MD , Chief Medical Officer, Assistant Commissioner, Director of Communicable Disease Control, Acting Director State Laboratory Inst, Massachusetts Department of Public Health, Jamaica Plain, MA
Elena Naumova, PhD , Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA
Background: With the introduction of anti-retroviral therapy, HIV-positive persons are surviving to an older age in the US. Persons aged ≥65 are a high risk group for influenza-related complications, because of age- associated immune dysfunction. HIV infection in the elderly may have a synergistic effect with aging, and increase the severity of influenza-related complications in such persons. Design: Using hospitalization claims data maintained by the Center for Medicare and Medicaid Services (CMS) over a 14-year period, we described the demographic and temporal patterns of Pneumonia and Influenza (P&I) hospitalizations in HIV-positive and -negative seniors, and compared outcome of P&I hospitalization with respect to HIV status. Results: The proportion of seniors hospitalized for P&I with concurrent HIV more than doubled between 1991 and 2004, from 27 to 56 per 100,000 P&I hospitalizations respectively. HIV-positive seniors were younger on average than HIV-negative seniors (70 years vs. 80 years, P<0.001). In-hospital death was more frequent among HIV-positive records (18% vs. 13% for HIV-negative persons, P<0.001). The proportion of HIV-positive persons who died in hospital declined over the 14-year period (from 30% in 1991 to 15% in 2004). A gap in in-hospital mortality nevertheless persisted in 2004, with HIV-positive persons being 50% more likely to die during the course of P&I hospitalization compared to HIV-negative persons (P<0.001). Conclusion: HIV-infected persons represent an expanding fraction of the elderly population that is hospitalized with P&I. Efforts to improve outcomes of P&I in seniors should include not only immunization of HIV-positive persons but also increased HIV screening.

Learning Areas:
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
1- Describe the differences in demographics and temporality of Pneumonia and Influenza (P&I)hospitalizations with respect to HIV status in the elderly from 1991 to 2004. 2- Compare hospitalization outcome (in-hospital death), in the elderly with P&I with respect to HIV status.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I perform literature search, analysis, and initial write-up for the paper.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.