 |
|
|
| |
HIV+ >65 on Medicare Have 2 Times More Comorbidities vs HIV-neg AND Blacks & Latinos Have 4-Fold Increased Risk for the 5 Comorbidities Examined vs Whites - CDC Report
Chronic health conditions in medicare beneficiaries 65 years and older with HIV infection.
|
| |
| |
Download the PDF here
"Research has begun to focus on the threats to health of older PLWHIV, both those due to normal aging processes, as well as those due to their HIV infection. There is evidence that older PLWHIV experience age-related illnesses earlier in life, or in a more severe form than their non-HIV infected counterparts (6). It is hypothesized that the greater severity and earlier onset of these diseases may be due to the changes in immunity and inflammation caused by HIV infection (5). PLWHIV appear to be more likely to suffer from classic age-related comorbidities such as cardiovascular disease, diabetes, and renal failure than their non-infected, age-matched counterparts (7). There are also concerns that HAART drug regimens may cause damage to the kidneys and liver in certain PLWHIV, and that drug toxicity could interact with age-related declines in organ function (8, 9). Many HAART drugs have also been associated with abnormal lipid profiles, which can increase the risk of cardiovascular diseases and diabetes (10, 11). It is also possible that PLWHIV are more prone to age related chronic diseases due to high prevalence of harmful behaviors, such as substance abuse (12-14)."
"HIV+ beneficiaries were approximately twice as likely as those without HIV infection to have chronic condition flags indicating hypertension, hyperlipidemia, ischemic heart disease, rheumatoid arthritis/osteoarthritis, or diabetes (Table 2). Adjusted risks for these chronic conditions ranged from aOR 1.51 95% CI (1.47, 1.55) for diabetes to aOR 2.14 95% CI (2.08, 2.19) for rheumatoid arthritis/osteoarthritis (Table 3)......[ from Jules: Male African American and Hispanic beneficiaries were more than 3 times as likely to have HIV for each level of the chronic condition index as compared to white females with the same number of chronic conditions (data not shown). In table 3 you can see Blacks & Latinos had on average 4-fold increased risk for the comorbidities listed here compared to Whites, and also 3-4 times more likely to have 5 or more comorbidities compared to Whites (Table 4). ]
Study looked at Medicare beneficiaries .......this is the first and largest study of PLWHIV >65 years old......This study is in agreement with many previous studies that have found higher prevalence of disease, or increased risk for cardiovascular diseases, arthritis, and diabetes
among persons with HIV, both among those >50 years of age and those not focused on older persons. You can see in this table 2, HIV+ had about 2-fold increase Odds Ratio vs HIV- for having these comorbidities: hypertension, hyperlipidemia, heart disease, rheumatoid/osteoarthritis, and diabetes. And increased risk for multiple comorbidities with an 8-fold higher risk for 5 or more comorbidities.....83% of study participants were White, 7.7% Black, with HIV (7, 11, 38).
AGE: Non-HIV care provider....Aging, Worse Still to Come?....Aging Clinic at Weill-Cornell, NYC; aging $costs in HIV skyrocket - (09/29/16)
Cost estimates of living with HIV in the U.S. range considerably depending on demographic and HIV related factors; but estimates using 2005 and 2006 data range from $10,000 to $40,000 per year (28, 29). Costs associated with multiple chronic health problems are also high. Data from 2005 Medicare expenditure costs, indicate that the annual costs for Medicare beneficiaries with one chronic condition are $7,172, and for beneficiaries with three or more chronic conditions $32,498 (30 )."
"Beneficiaries with HIV infection were also more likely than those without HIV infection to have one or more of the five most common chronic health conditions, increasing the complexity of their medical issues, care, and likelihood of ill health after age 65. Cost estimates of living with HIV in the U.S. range considerably depending on demographic and HIV related factors; but estimates using 2005 and 2006 data range from $10,000 to $40,000 per year (28, 29). Costs associated with multiple chronic health problems are also high. Data from 2005 Medicare expenditure costs, indicate that the annual costs for Medicare beneficiaries with one chronic condition are $7,172, and for beneficiaries with three or more chronic conditions $32,498 (30 ).
This study identified 24,735 FFS Medicare beneficiaries who were >65 years with HIV infection, which represents 78% of the total number of PLWHIV >65 years identified in the Centers for Disease Control and Prevention National surveillance data for 2009 (2).
This study adds to the growing body of literature on older PLWHIV in the U.S. Historically PLWHIV have entered the Medicare health system as beneficiaries with social security disability benefits. However with the aging HIV-positive patient population, HIV providers in the Medicare network will have to prepare for patients with different medical needs, including a higher likelihood of chronic co-morbid health conditions. Similarly, chronic disease practitioners who serve in the Medicare network, such as cardiologists and endocrinologists, should be aware that their Medicare patients may be receiving treatment for HIV infection. Greater collaboration between infectious disease and chronic disease practitioners will be needed to ensure the appropriate medical management of these patients including complex medication regimes (31, 32).
few studies have subdivided this category further, or included substantial numbers of persons >65 years of age There is a lack of knowledge about the health of PLWHIV >65 years compared to that of their non-HIV infected counterparts, including their prevalence of chronic diseases. The objective of this study is to examine sociodemographic factors and chronic health conditions of PLWHIV aged >65 years and older, and to compare their chronic disease prevalence to beneficiaries without HIV.
This is the first and largest study to the authors' knowledge to examine chronic conditions among PLWHIV who are exclusively >65 years of age. Previous studies have examined frequencies of chronic conditions among PLWHIV >50 years but few of these studies have included large numbers of participants 65 years and older (33-37). This study is in agreement with many previous studies that have found higher prevalence of disease, or increased risk for cardiovascular diseases, arthritis, and diabetes among persons with HIV, both among those >50 years of age and those not focused on older persons with HIV (7, 11, 38)."
---------------------------
Chronic health conditions in medicare beneficiaries 65 years and older with HIV infection.
AIDS July 2016 Friedman, Eleanor E.; Duffus, Wayne A.
ASPPH/CDC Public Health Fellow Centers for Disease Control and Prevention
Abstract
Objectives: to examine sociodemographic factors and chronic health conditions of people living with HIV (PLWHIV/ HIV+) >=65 years, and to compare their chronic disease prevalence to beneficiaries without HIV.
Design: National fee for service (FFS) Medicare claims data (parts A and B) from 2006-2009 were used to create a retrospective cohort of beneficiaries >65 years old.
Methods: Beneficiaries with 1 inpatient or skilled nursing facility claim, or 2 outpatient claims with HIV diagnosis codes were considered HIV+. HIV+ beneficiaries were compared to uninfected beneficiaries on demographic factors and on the prevalence of hypertension, hyperlipidemia, ischemic heart disease, rheumatoid arthritis/osteoarthritis, and diabetes. Odds ratios (OR), 95% confidence intervals (CI), and p-values were calculated. Adjustment variables included age, sex, race/ethnicity, end stage renal disease (ESRD), and dual Medicare-Medicaid enrollment. Chronic conditions were examined individually, and as an index from zero to all five conditions.
Results: Of 29,060,418 eligible beneficiaries, 24,735 (0.09%) were HIV+. HIV+ beneficiaries were more likely to be Hispanic, African American, male, and younger (p>0.0001), and were 1.5 to 2.1 times as likely to have a chronic disease (diabetes (aOR) 1.51 95% CI (1.47, 1.55): rheumatoid arthritis/osteoarthritis 2.14 95% CI (2.08, 2.19)), and 2.4 to 7 times as likely to have 1-5 co-morbid chronic conditions (1 condition (aOR) 2.38 95% CI (2.21, 2.57): 5 conditions 7.07 95% CI (6.61, 7.56)).
Conclusions: Our results show that PLWHIV >=65 years are at higher risk of comorbidities than other FFS Medicare beneficiaries. This finding has implications for both the management and cost of the health of PLWHIV >=65.
Introduction:
Recent epidemiologic reviews of persons living with human immunodeficiency virus (PLWHIV) in the United States have indicated that those ≥50 years old represent an increasing proportion of those
infected (1). In 2011 about 36% of all PLWHIV in the United States and six territories were persons >50 years of age (2). This group of PLWHIV is expanding largely due to increased length of survival after HIV infection, rather than increased numbers of infections and diagnoses (1). Survival time for PLWHIV has increased significantly since the introduction of highly active antiretroviral therapy
(HAART) in 1996. Recent cohort trials have indicated that PLWHIV now have a lifespan close to that of non-HIV infected persons (3, 4). With appropriate antiretroviral management, it is expected that
increasing numbers of PLWHIV will survive into older age, with some estimating that by 2020, half of all PLWHIV will be >50 years (5).
Research has begun to focus on the threats to health of older PLWHIV, both those due to normal aging processes, as well as those due to their HIV infection. There is evidence that older PLWHIV
experience age-related illnesses earlier in life, or in a more severe form than their non-HIV infected counterparts (6). It is hypothesized that the greater severity and earlier onset of these diseases may be
due to the changes in immunity and inflammation caused by HIV infection (5). PLWHIV appear to be more likely to suffer from classic age-related comorbidities such as cardiovascular disease, diabetes, and renal failure than their non-infected, age-matched counterparts (7). There are also concerns that HAART drug regimens may cause damage to the kidneys and liver in certain PLWHIV, and that drug toxicity could interact with age-related declines in organ function (8, 9). Many HAART drugs have also been associated with abnormal lipid profiles, which can increase the risk of cardiovascular diseases and diabetes (10, 11). It is also possible that PLWHIV are more prone to age related chronic diseases due to high prevalence of harmful behaviors, such as substance abuse (12-14).
Despite recent attention on older PLWHIV, there is still the need for more specific and in-depth research in this population. In particular, although many studies have included or even focused on
persons >50 years of age, few studies have subdivided this category further, or included substantial numbers of persons >65 years of age (15, 16). According to the Centers for Disease Control and Prevention in 2010 there were an estimated 35,000 PLWHIV who were >65 years of age, a number that will only get larger in the coming years (2). There is a lack of knowledge about the health of PLWHIV >65 years compared to that of their non-HIV infected counterparts, including their prevalence of chronic diseases. The objective of this study is to examine sociodemographic factors and chronic health conditions of PLWHIV aged >65 years and older, and to compare their chronic disease prevalence to beneficiaries without HIV.
Methods:
Americans >65 years almost universally receive their health insurance coverage from Medicare, and the majority (84-77% during 2006-2009) of these Medicare beneficiaries were fee for service (FFS)
enrollees, making FFS claims a comprehensive source to investigate the health of PLWHIV >65 years (17). Inclusion criteria for this study were as follows: enrollment in Parts A and B of Medicare
excluding those enrolled in a Health Maintenance Organization (Medicare Advantage/Medicare managed care programs), enrollment of 11 continuous months or more (or death) during the years 2006-
2009, and age range of >65 to 116 years of age (Figure 1). The minimum 11 month enrollment criteria, the inclusion of data from dead beneficiaries until their date of death, and the exclusion of persons
enrolled in an Health Maintenance Organizations are all practices recommended by the Chronic Condition Warehouse (CCW) for determining FFS beneficiaries (18). The upper age limit was chosen in order to include all beneficiaries who were plausibly alive, while excluding beneficiaries who were dead but did not have a confirmed death date. All data were de-identified and each individual was assigned a unique identifier by the Centers for Medicare & Medicaid Services (CMS) prior to analysis.
Excerpted
REsults
Out of all eligible persons, 99.7% of beneficiaries without HIV and 99.5% of beneficiaries with HIV were eligible starting on January 1st 2006, and contributed four full years of data to this study. Of the 29,060,418 eligible persons for this study 99.9% were HIV-, and 24,735 (0.09%) were HIV+.
The median age of PLWHIV was about 5 years younger than their non-HIV infected counterparts (p-value <0.0001). HIV+ beneficiaries were nearly twice as likely to be male, five times as likely to be African American or Hispanic and were also more likely to live in Florida, New York, California, Texas, or New Jersey (Table 1).
HIV+ beneficiaries were approximately twice as likely as those without HIV infection to have chronic condition flags indicating hypertension, hyperlipidemia, ischemic heart disease, rheumatoid arthritis/osteoarthritis, or diabetes (Table 2). Adjusted risks for these chronic conditions ranged from aOR 1.51 95% CI (1.47, 1.55) for diabetes to aOR 2.14 95% CI (2.08, 2.19) for rheumatoid arthritis/osteoarthritis (Table 3). Adjustment factors associated with HIV infection in multivariable models included being male, being of African American race or Hispanic ethnicity, having end stage renal disease, and dual eligibility for Medicaid and Medicare (Table 3). For male African American and Hispanic beneficiaries with chronic conditions, the likelihood of HIV infection was especially elevated in comparison to that of white female beneficiaries with the same chronic condition, with adjusted odds ratios ranging from 8.99 to 6.33 (data not shown).
For models that examined the number of chronic diseases as an index, PLWHIV were more likely than their non-infected counterparts to have one or more chronic conditions, with increasing risks seen for each additional comorbidity. While frequencies of having 2-4 chronic conditions were similar for persons with and without HIV, HIV+ beneficiaries were less likely to have no chronic conditions or one chronic condition (13.22% versus 25.66%), and were more likely to have 5 chronic conditions (22.11% versus 8.41%) (Table 2). Adjusted odds of having HIV infection and one or more comorbidities ranged from aOR 2.38 95% CI (2.21, 2.57) for having one condition to aOR 7.07 95% CI (6.61, 7.56) for having all five chronic conditions (Table 4).
Male African American and Hispanic beneficiaries were more than 3 times as likely to have HIV for each level of the chronic condition index as compared to white females with the same number of chronic conditions (data not shown).
DISCUSSION
This study found that age-eligible PLWHIV in Medicare were more likely to be of Hispanic ethnicity, African American race, male sex and younger than other age eligible Medicare beneficiaries. Beneficiaries with HIV infection were more likely to have originally enrolled in Medicare under disability benefits, to have been enrolled in Medicaid since 1999, and to have been dually enrolled in Medicaid and Medicare. Beneficiaries with HIV infection were also more likely than those without HIV infection to have one or more of the five most common chronic health conditions, increasing the complexity of their medical issues, care, and likelihood of ill health after age 65.
Increasing numbers of PLWHIV will use Medicare as their primary source of insurance as survival of HIV-positive persons extends to 50 years post-infection (3, 4). While historically Medicaid has been a major source of health insurance for PLWHIV, Medicaid is only responsible for insurance costs after all other third-party insurance payers, including Medicare, are billed for services (26). As greater numbers of PLWHIV enter Medicare as age-eligible beneficiaries, the majority of their care costs will shift from Medicaid to Medicare (27). This is important given that costs for HIV care are considerable, even without the additional costs seen when multiple chronic conditions are also considered. Cost estimates of living with HIV in the U.S. range considerably depending on demographic and HIV related factors; but estimates using 2005 and 2006 data range from $10,000 to $40,000 per year (28, 29). Costs associated with multiple chronic health problems are also high. Data from 2005 Medicare expenditure costs, indicate that the annual costs for Medicare beneficiaries with one chronic condition are $7,172, and for beneficiaries with three or more chronic conditions $32,498 (30 ).
|
| |
|
|
|
|
|
