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Predictors of mortality in HIV-associated hospitalizations in Portugal: a hierarchical survival model

2009-07-23Artigo científico Acesso aberto
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dc.contributor.authorDias, Sara S
dc.contributor.authorAndreozzi, Valeska
dc.contributor.authorMartins, M O
dc.contributor.authorTorgal, Jorge
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.institutionInstituto de Higiene e Medicina Tropical (IHMT)
dc.contributor.institutionGlobal Health and Tropical Medicine (GHTM)
dc.contributor.pblBioMed Central (BMC)
dc.date.accessioned2017-09-18T22:00:51Z
dc.date.available2017-09-18T22:00:51Z
dc.date.issued2009-07-23
dc.descriptionBMC Health Serv. Res. Dias, Sara S. Andreozzi, Valeska Martins, Maria O. Torgal, JorgePortuguese agency Fundacao para a Ciencia e Tecnologia The research of this paper was funded by the Portuguese agency Fundacao para a Ciencia e Tecnologia, providing PhD support to SSD. 44 BIOMED CENTRAL LTD LONDON 490SU
dc.description.abstractBackground: The beneficial effects of highly active antiretroviral therapy, increasing survival and the prevention of AIDS defining illness development are well established. However, the annual Portuguese hospital mortality is still higher than expected. It is crucial to understand the hospitalization behaviour to better allocate resources. This study investigates the predictors of mortality in HIV associated hospitalizations in Portugal through a hierarchical survival model. Methods: The study population consists of 12,078 adult discharges from patients with HIV infection diagnosis attended at Portuguese hospitals from 2005-2007 that were registered on the diagnosis-related groups' database. We used discharge and hospital level variables to develop a hierarchical model. The discharge level variables were: age, gender, type of admission, type of diagnoses-related group, related HIV complication, the region of the patient's residence, the number of diagnoses and procedures, the Euclidean distance from hospital to the centroid of the patient's ward, and if patient lived in the hospital's catchment area. The hospital characteristics include size and hospital classification according to the National Health System. Kaplan-Meier plots were used to examine differences in survival curves. Cox proportional hazard models with frailty were applied to identify independent predictors of hospital mortality and to calculate hazard ratios (HR). Results: The Cox proportional model with frailty showed that male gender, older patient, great number of diagnoses and pneumonia increased the hazard of HIV related hospital mortality. On the other hand tuberculosis was associated with a reduced risk of death. Central hospital discharge also presents less risk of mortality. The frailty variance was small but statistically significant, indicating hazard ratio heterogeneity among hospitals that varied between 0.67 and 1.34, and resulted in two hospitals with HR different from the average risk. Conclusion: The frailty model suggests that there are unmeasured factors affecting mortality in HIV associated hospitalizations. Consequently, for healthcare policy purposes, hospitals should not all be treated in an equal manner.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent11
dc.format.extent342000
dc.identifier.doi10.1186/1472-6963-9-125
dc.identifier.issn1472-6963
dc.identifier.otherPURE: 297922
dc.identifier.otherPURE UUID: 4492001a-b79d-4775-9b3b-695194872396
dc.identifier.otherresearchoutputwizard: 13322
dc.identifier.otherPubMed: 19627574
dc.identifier.otherWOS: 000269525600002
dc.identifier.otherScopus: 69049089830
dc.identifier.otherORCID: /0000-0002-7941-0285/work/69039782
dc.identifier.urihttp://hdl.handle.net/10362/23348
dc.language.isoeng
dc.peerreviewedyes
dc.subjectCOHORT
dc.subjectLIFE-TABLES
dc.subjectPUBLIC-HEALTH
dc.subjectAIDS
dc.subjectACTIVE ANTIRETROVIRAL THERAPY
dc.subjectINFECTED PATIENTS
dc.subjectTUBERCULOSIS
dc.subjectVIRAL-HEPATITIS
dc.subjectIMPACT
dc.subjectURBAN
dc.subjectACTIVE ANTIRETROVIRAL THERAPY
dc.subjectINFECTED PATIENTS
dc.subjectVIRAL-HEPATITIS
dc.subjectPUBLIC-HEALTH
dc.subjectLIFE-TABLES
dc.subjectTUBERCULOSIS
dc.subjectIMPACT
dc.subjectCOHORT
dc.subjectURBAN
dc.subjectAIDS
dc.subjectSDG 3 - Good Health and Well-being
dc.titlePredictors of mortality in HIV-associated hospitalizations in Portugal: a hierarchical survival modelen
dc.typejournal article
degois.publication.firstPage125
degois.publication.issueNA
degois.publication.lastPage135
degois.publication.titleBMC Health Services Research
degois.publication.volume9
dspace.entity.typePublication
rcaap.rightsopenAccess

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