Original ArticleDifferences in the use of health resources by Spanish and immigrant HIV-infected patientsDiferencias en el uso de recursos sanitarios entre pacientes con infección VIH españoles e inmigrantes
Introduction
Immigration is a growing and relatively new phenomenon in Spain. HIV-infected patients born abroad are an increasing proportion of HIV patients treated in Spain. In some series, HIV-infected immigrants reach almost 50% of the new HIV diagnosis.1
It is well known that a highly active antiretroviral therapy reduces the incidence of opportunistic infections but its cost is high. Direct costs of HIV health care have been evaluated in the literature, especially after the introduction of HAART.2, 3, 4 It is assumed that immigrants may demand a higher use of healthcare services because of socio-economic vulnerability. However, the specific impact of the immigrant population with HIV infection on health services use and related cost has hardly been analysed.5, 6 An understanding of healthcare use patterns is important for optimisation of care and resource allocation.
This study was designed to compare resource use patterns between immigrant and Spanish HIV-infected patients and to estimate the direct health care costs of HIV/AIDS care in both groups of patients.
Section snippets
Patients and methods
All adult patients with HIV infection treated during the years 2003–2005 (from 01/01/2003 to 12/31/2005) in our institution were included. HIV patients were actively identified by electronic records. An immigrant was considered a patient not born in Spain. Basic epidemiological data were registered for each patient: sex, age, risk group, continent of origin, year of diagnosis of HIV infection, year of AIDS diagnosis, CDC classification at diagnosis of HIV, description of first opportunistic
Results
A total of 372 patients were seen during the period of study, 88% (n = 329) Spanish. They were 24% women, mean age 40.3 (7.8) years, and the most frequent risk group was illicit drug use (60%). At the diagnosis of HIV, a total of 23.7% had AIDS. The most frequent opportunistic diseases were extrapulmonary tuberculosis, pneumonia, and Pneumocystis jirovecii pneumonia. During the period of the study, patients had a mean CD4 count of 466.2 (307.6) cell/cc and viral load 2.4 (1.2) log cop/ml.
Immigrants
Discussion
In the present study, we have analysed the distribution of resource use in immigrant and Spanish HIV patients, and we have not found large differences in the overall pattern of usage. It has been argued that immigrants make greater use of healthcare services, but there is a lack of published data to support this contention. Even though, some studies have indicated that health services use is lower among the immigrant population than among the host population.9, 10, 11 Our finding of similar
Funding
The study was supported in part by a grant from FIPSE 36296/02 and FIPSE 36690/07 (Fundación para la Investigación y Prevención del SIDA en España), program of stabilisation of researchers 2007 from Instituto de Salud Carlos III (María Velasco) and funds from Instituto Madrileño de Salud, Comunidad Autónoma de Madrid.
Conflict of interest
The authors declare no conflict of interest.
Acknowledgements
We thank Dr Martin Ríos for critically reviewing the Methods section of the manuscript.
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