Background
Methods
Ordinances | |||||||
---|---|---|---|---|---|---|---|
MCD* | DRG** | Designation | 348-B/1998 | 189/2001 | 132/2003 | 567/2006 | 132/2009 |
25 HIV infection
| 488 | HIV with an extensive procedure in the operating room. | € 2,193.50 | € 11,889.72 | € 13,099.08 | ||
489 | HIV with a significant related clinical situation. | € 1,121.30 | € 7,181.14 | € 7,911.56 | |||
490 | HIV with procedures in the operating room without other related situations. | € 664.80 | € 3,007.10 | € 33,212.97 | |||
24 HIV infection
| 700 | Tracheostomy for HIV. | € 39,162.25 | € 40,062.90 | |||
701 | Infection with HIV and an operation and ventilation or nutritional support. | € 14,467.48 | € 14,800.20 | ||||
702 | HIV infection with an operation room procedure and multiple related major infections. | € 11,771.16 | € 12,041.88 | ||||
703 | HIV infection with a block operative procedure and related major diagnosis. | € 10,433.90 | € 10,673.86 | ||||
704 | HIV infection with an operating room procedure with no related major diagnosis. | € 6,235.18 | € 6,378.58 | ||||
705 | HIV infection with multiple related major infections, including tuberculosis. | € 8,737.55 | € 8,938.49 | ||||
706 | HIV infection with multiple related major infections, not including tuberculosis. | € 8,666.81 | € 8,866.13 | ||||
707 | HIV infection with a nutritional support or ventilator. | € 8,421.56 | € 8,615.24 | ||||
708 | HIV infection with a related major diagnosis, discharge against medical advice. | € 3,597.43 | € 3,680.16 | ||||
709 | HIV infection with multiple related major diagnoses or significant diagnoses, including tuberculosis. | € 8,322.24 | € 8,513.64 | ||||
710 | HIV infection with multiple related major diagnoses or significant diagnoses, not including tuberculosis. | € 5,896.94 | € 6,032.56 | ||||
711 | HIV infection with a major related diagnosis without multiple related major or significant diagnoses, including tuberculosis. | € 5,030.96 | € 5,146.67 | ||||
712 | HIV infection with a major related diagnosis without multiple related major or significant diagnoses, not including tuberculosis. | € 3,277.22 | € 3,352.59 | ||||
713 | HIV infection associated with a significant diagnosis, discharge against medical advice. | € 1,847.90 | € 1,890.40 | ||||
714 | HIV infection with significant related diagnosis. | € 2,980.44 | € 3,048.99 | ||||
715 | HIV infection with other related diagnoses. | € 1,725.63 | € 1,765.32 | ||||
716 | HIV infection with no other related diagnoses. | € 1,568.69 | € 1,604.77 |
Analysis
Ethical standards
Results
Linear regression | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Variables | Total | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | slop | 95% IC |
Mid-year populations of persons living with HIV* | 4,466 | 4,993 | 5,524 | 6,010 | 6,437 | 6,854 | 7,213 | 7,521 | 7,819 | 8,052 | 8,289 | 382.127 | [341.991:422.264] | |
HIV/AIDS hospitalization frequency |
57,027
| 5,459 | 5,550 | 5,654 | 5,628 | 5,468 | 5,491 | 5,214 | 5,089 | 4,894 | 4,326 | 4,254 | −132.118 | [−186.756: −77.480] |
Hospitalization rate# | 1.2 | 1.1 | 1.0 | 0.9 | 0.8 | 0.8 | 0.7 | 0.7 | 0.6 | 0.5 | 0.5 | −0.069 | [−0.078: −0.060] | |
Gender (% male) |
73
| 76 | 76 | 76 | 74 | 74 | 73 | 74 | 72 | 70 | 70 | 70 | −0.691 | [−0.854:−0.528] |
Age (mean) |
39
| 35 | 37 | 38 | 38 | 39 | 41 | 41 | 42 | 42 | 43 | 44 | 0.827 | [0.709:0.946] |
Median LOS (days) |
11
| 12 | 12 | 12 | 11 | 12 | 12 | 11 | 11 | 11 | 10 | 10 | −0.200 | [−0.296:−0.104] |
In-hospital mortality (%) |
14.4
| 14.9 | 15.5 | 15.4 | 15.1 | 14.9 | 14.8 | 13.8 | 13.4 | 13.1 | 13.4 | 13.1 | −0.262 | [−0.349:−0.175] |
Average cost (€) |
5,148.7
| 997.7 | 4,818.1 | 6,062.0 | 6,625.6 | 6,689.7 | 6,640.8 | 5.676.4 | 4,480.0 | 4,670.4 | 4,594.1 | 4,664.0 | 72.329 | [−293.079:437.737] |
Total cost in M (€) |
293,614
| 5,446 | 26,740 | 34,274 | 37,288 | 36,579 | 36,464 | 29,596 | 22,798 | 22,856 | 19,874 | 19,840 | −233.736 | [−2437.823:1970.350] |
NUTS II / Year | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | Total | % Change (2000–2010) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Norte, N
|
1,191
|
1,274
|
1,356
|
1,298
|
1,327
|
1,473
|
1,384
|
1,374
|
1,294
|
1,208
|
1,139
|
14,318
|
−4.4
|
Median LOS | 12 | 11 | 11 | 12 | 13 | 12 | 10 | 11 | 10 | 9 | 9 | 10.9 | −25 |
% Death | 19.1 | 17.7 | 17.6 | 16.4 | 15.4 | 15.3 | 11.7 | 13.8 | 12.8 | 13.5 | 11.4 | 15.0 | −40.1 |
Centro, N
|
415
|
449
|
563
|
552
|
528
|
565
|
539
|
535
|
604
|
536
|
546
|
5,832
|
31.6
|
Median LOS | 11 | 11 | 11 | 11 | 11 | 10 | 10 | 11 | 10 | 10 | 9 | 10.4 | −18.2 |
% Death | 10.1 | 9.4 | 12.4 | 8.9 | 10.8 | 11.3 | 14.8 | 11.2 | 7.3 | 7.5 | 7.7 | 10.1 | −24.0 |
Lisbon, N
|
3,511
|
3,412
|
3,319
|
3,366
|
3,237
|
3,020
|
2,908
|
2,712
|
2,609
|
2,226
|
2,272
|
32,592
|
−35.3
|
Median LOS | 12 | 12 | 12 | 11 | 12 | 12 | 12 | 11 | 12 | 11 | 11 | 11.6 | −8.3 |
% Death | 14.5 | 16.1 | 15.0 | 15.7 | 15.3 | 15.2 | 14.5 | 13.8 | 14.2 | 14.4 | 15.0 | 14.9 | 3.4 |
Alentejo, N
|
76
|
100
|
103
|
132
|
111
|
143
|
137
|
129
|
114
|
98
|
91
|
1,234
|
19.7
|
Median LOS | 11 | 10 | 13 | 11 | 12 | 10 | 9 | 9 | 11 | 10 | 9 | 10.4 | −18.2 |
% Death | 17.1 | 12.0 | 24.3 | 15.2 | 22.5 | 16.8 | 17.5 | 17.1 | 19.3 | 19.4 | 23.1 | 18.4 | 34.9 |
Algarve, N
|
266
|
315
|
313
|
280
|
265
|
290
|
246
|
339
|
273
|
258
|
206
|
3,051
|
−22.6
|
Median LOS | 12 | 12 | 11 | 10 | 11 | 12 | 12 | 11 | 11 | 14 | 13 | 11.7 | 8.3 |
% Death | 8.3 | 10.2 | 12.1 | 14.6 | 12.8 | 14.1 | 12.2 | 11.2 | 14.3 | 14.3 | 12.6 | 12.4 | 52.6 |
Total, N
|
5,459
|
5,550
|
5,654
|
5,628
|
5,468
|
5,491
|
5,214
|
5,089
|
4,894
|
4,326
|
4,254
|
57,027
|
−22.1
|
Median LOS | 11.5 | 11.2 | 11.6 | 11.0 | 11.8 | 11.2 | 8.0 | 10.6 | 10.8 | 10.8 | 10.2 | 11.0 | −8.9 |
% Death | 14.9 | 15.5 | 15.4 | 15.1 | 14.9 | 14.8 | 13.8 | 13.4 | 13.1 | 13.4 | 13.1 | 14.4 | −11.7 |
Year | Norte | Centro | Lisbon | Alentejo | Algarve | |||||
---|---|---|---|---|---|---|---|---|---|---|
Mean(€) | (95% IC) | Mean(€) | (95% IC) | Mean(€) | (95% IC) | Mean(€) | (95% IC) | Mean(€) | (95% IC) | |
2000
| 1051.0 | (1036.8–1065.2) | 953.7 | (925.2–982.2) | 1024.0 | (1014.2–1033.8) | 982.7 | (926.0–1039.4) | 977.3 | (939.4–1015.2) |
2001
| 5099.2 | (4928.6–5269.9) | 4597.4 | (4327.0–4867.8) | 4808.6 | (4699.8–4917.5) | 4961.2 | (4324.1–5598.3) | 4624.3 | (4281.1–4967.4) |
2002
| 6480.8 | (6376.0–6585.6) | 5654.6 | (5471.4–5837.7) | 6209.4 | (6126.9–6291.9) | 6356.6 | (5986.9–6726.4) | 5608.6 | (5353.4–5863.8) |
2003
| 7137.9 | (7006.4–7269.4) | 6393.4 | (6183.0–6603.9) | 6798.8 | (6710.4–6887.3) | 6370.8 | (5911.5–6830.2) | 6427.0 | (6140.4–6713.7) |
2004
| 7181.7 | (7058.0–7305.3) | 6593.4 | (6372.1–6814.7) | 6855.2 | (6766.0–6944.4) | 6418.4 | (5944.1–6892.7) | 6399.7 | (6099.1–6700.3) |
2005
| 6894.7 | (6772.8–7016.6) | 6474.0 | (6243.6–6704.4) | 6746.2 | (6651.4–6840.9) | 6459.4 | (6061.0–6857.8) | 6629.9 | (6339.5–6920.4) |
2006
| 5924.8 | (5777.3–6072.3) | 5286.5 | (5044.9–5528.1) | 6056.5 | (5946.7–6166.3) | 5601.4 | (5096.8–6105.9) | 5512.6 | (5181.2–5844.1) |
2007
| 5110.8 | (4936.9–5284.8) | 3793.2 | (3579.2–4007.2) | 4951.4 | (4818.9–5083.8) | 4335.4 | (3541.7–5129.0) | 4209.3 | (3921.6–4497.0) |
2008
| 5301.3 | (5103.1–5499.6) | 3930.2 | (3717.3–4143.1) | 5053.6 | (4903.7–5203.5) | 4403.5 | (3849.7–4957.3) | 4663.4 | (4019.3–5307.5) |
2009
| 4907.5 | (4705.1–5109.9) | 4244.9 | (3956.7–4533.1) | 4995.3 | (4814.3–5176.3) | 3898.9 | (3375.5–4422.2) | 4923.9 | (4450.5–5397.3) |
2010
| 4733.4 | (4553.7–4913.1) | 3919.6 | (3640.1–4199.1) | 4917.4 | (4759.6–5075.1) | 5169.6 | (3923.7–6415.5) | 4579.8 | (4169.3–4990.4) |
All years
| 5499.9 | (5555.0–5444.9) | 4739.8 | (4822.1–4657.6) | 5293.2 | (5332.5–5.254.0) | 5210.9 | (5411.8–5009.9) | 4999.5 | (5123.3–4875.7) |
Comorbidity | Frequency | % | Male (n = 41,834) | Female(n = 15,210) | LOS/SCm* | |||
---|---|---|---|---|---|---|---|---|
% | ‰¥ | % | ‰¥ |
(Median)
| p-value# | |||
Paralysis | 708 | 1 | 76 | 13 | 24 | 11 | 12 | <0.001 |
Blood loss and anemia | 1,943 | 3 | 71 | 33 | 29 | 37 | 8 | <0.001 |
Valvular heart disease | 620 | 1 | 74 | 11 | 26 | 11 | 8 | <0.001 |
Deficiency anemia | 1,889 | 3 | 65 | 30 | 35 | 43 | 6 | <0.001 |
Depression | 1,597 | 3 | 77 | 27 | 23 | 22 | 6 | <0.001 |
Weight loss | 3,753 | 7 | 73 | 66 | 27 | 66 | 5 | <0.001 |
Pulmonary circulation disorders | 414 | 1 | 65 | 6 | 36 | 10 | 5 | <0.001 |
Peptic ulcer disease excluding bleeding | 205 | 0 | 45 | 2 | 55 | 8 | 5 | <0.001 |
Hypothyroidism | 148 | 0 | 37 | 1 | 64 | 6 | 5 | <0.001 |
Other neurological disorders | 3,329 | 6 | 78 | 60 | 22 | 46 | 4 | <0.001 |
Metastatic cancer | 537 | 1 | 81 | 10 | 19 | 7 | 4 | <0.001 |
Rheumatoid arthritis/collagen vascular diseases | 490 | 1 | 68 | 9 | 32 | 11 | 4 | <0.001 |
Diabetes, complicated | 397 | 1 | 65 | 6 | 35 | 9 | 4 | 0.008 |
Peripheral vascular disorders | 230 | 0 | 87 | 5 | 14 | 2 | 4 | <0.001 |
Fluid and electrolyte disorders | 5,189 | 9 | 85 | 93 | 15 | 46 | 3 | <0.001 |
Solid tumor without metastasis | 2,905 | 5 | 82 | 57 | 18 | 34 | 3 | <0.001 |
Congestive heart failure | 1,029 | 2 | 73 | 18 | 27 | 19 | 3 | <0.001 |
Cardiac arrhythmias | 877 | 2 | 71 | 15 | 29 | 17 | 3 | <0.001 |
Psychoses | 616 | 1 | 71 | 11 | 29 | 12 | 3 | <0.001 |
Liver disease | 13,905 | 24 | 80 | 264 | 21 | 188 | 2 | <0.001 |
Alcohol abuse | 4,578 | 8 | 73 | 91 | 27 | 92 | 2 | <0.001 |
Coagulopathy | 3,187 | 6 | 73 | 58 | 27 | 59 | 2 | <0.001 |
Chronic pulmonary disease | 2,458 | 4 | 66 | 39 | 34 | 55 | 2 | <0.001 |
Lymphoma | 1,471 | 3 | 55 | 21 | 45 | 48 | 2 | <0.001 |
Hypertension, uncomplicated | 2,191 | 4 | 67 | 35 | 33 | 47 | 1 | 0.001 |
Diabetes, uncomplicated | 1,709 | 3 | 70 | 29 | 30 | 34 | 1 | 0.062 |
Hypertension, complicated | 518 | 1 | 72 | 9 | 28 | 9 | 1 | 0.001 |
Renal failure | 1,929 | 3 | 66 | 31 | 34 | 43 | 0 | 0.425 |
Drug abuse | 16,978 | 30 | 81 | 329 | 19 | 211 | 0 | 0.037 |
Obesity | 225 | 0 | 76 | 4 | 24 | 3 | −1 | 0.047 |
Independent variables | N (% dead) | OR unadjusted | 95% C.I. | OR adjusted | 95% C.I. |
---|---|---|---|---|---|
Age groups - years of age
| |||||
1 - 0 to 17 | 1,057 (2.9) | 1 | 1 | ||
2 - 18 to 45 | 40,635 (13.3) | 5.068 | (3.541–7.253) | 4.318 | (2.980–6.257) |
3 - 46 to 65 | 12,803 (17.1) | 6.837 | (4.769–9.802) | 5.556 | (3.826–8.069) |
4 - 66 and older | 2,544 (22.9) | 9.840 | (6.803–4.232) | 7.955 | (5.424–11.669) |
Sex
| |||||
Female | 15,210 (11) | 1 | 1 | ||
Male | 41,834 (15.6) | 1.500 | (1.417–1.589) | 1.407 | (1.326–1.494) |
LOS median (alive/deceased)
| 11.0 / 12.0 | 1.005 | (1.005–1.006) | 1.004 | (1.003–1.005) |
Elixhauser comorbidity measures
| |||||
No comorbidity* | 16,850 (9.7) | 1 | 1 | ||
Metastatic cancer | 537 (41.5) | 4.319 | (3.632–5.136) | 3.286 | (2.732–3.952) |
Weight loss | 3,753 (30.8) | 2.917 | (2.710–3.140) | 2.501 | (2.312–2.704) |
Fluid and electrolyte disorders | 5,189 (29.9) | 2.897 | (2.715–3.091) | 2.332 | (2.176–2.499) |
Lymphoma | 1,471 (27.5) | 2.319 | (2.063–2.607) | 2.260 | (2.000–2.553) |
Pulmonary circulation disorders | 414 (22.9) | 1.782 | (1.416–2.244) | 2.132 | (1.651–2.754) |
Cardiac arrhythmias | 877 (31.1) | 2.749 | (2.379–3.178) | 2.030 | (1.734–2.375) |
Solid tumor without metastasis | 2,905 (24.1) | 1.973 | (1.806–2.156) | 1.706 | (1.552–1.876) |
Coagulopathy | 3,187 (23.8) | 1.953 | (1.794–2.126) | 1.668 | (1.524–1.825) |
Blood loss and anemia | 1,943 (22.6) | 1.780 | (1.596–1.985) | 1.573 | (1.403–1.764) |
Peripheral vascular disorders | 230 (23.9) | 1.877 | (1.385–2.544) | 1.416 | (1.025–1.956) |
Congestive heart failure | 1,029 (22.6) | 1.765 | (1.522–2.046) | 1.403 | (1.195–1.648) |
Other neurological disorders | 3,329 (20.2) | 1.551 | (1.420–1.694) | 1.364 | (1.242–1.498) |
Paralysis | 708 (21.6) | 1.654 | (1.380–1.981) | 1.331 | (1.097–1.614) |
Renal failure | 1,929 (18.9) | 1.403 | (1.248–1.576) | 1.221 | (1.080–1.381) |
Peptic ulcer disease excluding bleeding | 205 (20.5) | 1.537 | (1.094–2.159) | 1.208 | (0.843–1.733) |
Alcohol abuse | 4,578 (18.1) | 1.348 | (1.245–1.459) | 1.151 | (1.057–1.253) |
Liver disease | 13,905 (15.2) | 1.087 | (1.030–1.147) | 1.027 | (0.969–1.088) |
Hypertension, uncomplicated | 2,191 (12.7) | 0.861 | (0.757–0.978) | 0.685 | (0.597–0.785) |
Chronic pulmonary disease | 2,458 (11) | 0.726 | (0.638–0.825) | 0.542 | (0.470–0.625) |
Depression | 1,597 (9.8) | 0.642 | (0.544–0.759) | 0.533 | (0.447–0.635) |
Nutrient-deficiency anemia | 1,889 (10.7) | 0.706 | (0.609–0.818) | 0.531 | (0.455–0.621) |
Obesity | 225 (7.1) | 0.455 | (0.273–0.757) | 0.474 | (0.281–0.799) |