Rural Residence Is Associated With Delayed Care Entry and Increased Mortality Among Veterans With Human Immunodeficiency Virus Infection
Bibliographic Data
| ID | 9099260 |
|---|---|
| Authors | Michael Ohl (0000-0002-3120-7915, University of Iowa, corresponding author), Janet Tate (VA Connecticut Healthcare System), Mona Duggal (0000-0002-9404-2871, Yale University), Melissa Skanderson (0000-0002-5539-8680, VA Connecticut Healthcare System), Matthew Scotch (0000-0001-5100-9724, Yale University), Peter J Kaboli (0000-0003-0993-0952, University of Iowa, corresponding author), Peter Kaboli, Mary Vaughan-Sarrazin, Mary Vaughan‐Sarrazin (0000-0001-8717-1061, University of Iowa, corresponding author), Amy C Justice (0000-0003-0139-5502, Yale University, corresponding author), Amy Justice |
| Year | 2010 |
| Volume | 48 |
| Issue | 12 |
| Pages | 1064-1070 |
| Publication date | 2010-12-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0b013e3181ef60c2 |
| PMID | 20966783 |
| PMCID | PMC3138500 |
| OpenAlex | W2087131446 |
| Language | EN |
| Citations received | 21 |
| References cited | 27 |
CONTEXT: Rural persons with human immunodeficiency virus (HIV) face many barriers to care, but little is known about rural-urban variation in HIV outcomes. OBJECTIVE: To determine the association between rural residence and HIV outcomes. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study of mortality among persons initiating HIV care in Veterans Administration (VA) during 1998-2006, with mortality follow-up through 2008. Rural residence was determined using Rural Urban Commuting Area codes. We identified 8489 persons initiating HIV care in VA with no evidence of combination antiretroviral therapy (cART) use at care entry, of whom 705 (8.3%) were rural. OUTCOME MEASURE: All-cause mortality. RESULTS: At care entry, rural persons were less likely than urban persons to have drug use problems (10.6% vs. 19.5%, P < 0.001) or hepatitis C (34.3% vs. 41.2%, P = 0.001), but had more advanced HIV infection (median CD4: 186 vs. 246, P < 0.001). By 2 years after care entry, 5874 persons had initiated cART (528 rural [74.9%] and 5346 urban [68.7%], P = 0.001), and there were 1022 deaths (108 rural [15.3%] and 914 urban [11.7%], P = 0.004). The mortality hazard ratio for rural persons compared with urban was 1.34 (95% confidence interval: 1.05-1.69). The hazard ratio decreased to 1.18 (95% confidence interval: 0.93-1.50) after adjustment for HIV severity (CD4 and AIDS-defining illnesses) at care entry, and was 1.17 (95% confidence interval: 0.92-1.50) in a model adjusting for age, HIV severity at care entry, substance use, hepatitis B or C diagnoses, and cART initiation. CONCLUSIONS: Later entry into care drives increased mortality for rural compared with urban veterans with HIV. Future studies should explore the person, care system, and community-level determinants of late care entry for rural persons with HIV
Cohort study · Confidence interval · Hazard ratio · Residence · Retrospective cohort study · Rural area · Demography · HIV-related health complications and treatments · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Internal Medicine · Medicine · Gerontology
Barriers to Care for Rural People Living With HIV
Acceptability, Feasibility, and Preliminary Impact of 4 Remotely-Delivered Interventions for Rural Older Adults Living with HIV
Assessing the Health Outcomes of the Food Access Pilot Project
Antiretroviral Adherence Among Rural Compared to Urban Veterans with HIV Infection in the United States
Predictors of Linkage to Care Following Community-Based HIV Counseling and Testing in Rural Kenya
Health Care Facility Characteristics are Associated with Variation in Human Immunodeficiency Virus Pre-exposure Prophylaxis Initiation in Veteran’s Health Administration
Neighborhood characteristics and HIV treatment outcomes
Risk factors for Aids-defining illnesses among a population of poorly adherent people living with HIV/Aids in Atlanta, Georgia
A qualitative assessment of barriers to healthcare and HIV prevention services among men who have sex with men in non-metropolitan areas of the south
Is there a rural/urban gap in the quality of HIV care for treatment-naïve HIV-positive individuals initiating antiretroviral therapy in British Columbia
Associations between population density and clinical and sociodemographic factors in women living with HIV in the Southern United States
Washington state satellite HIV clinic program
Differences in Receipt of Alcohol‐Related Care Across Rurality Among VA Patients Living With HIV With Unhealthy Alcohol Use
Factors associated with lack of care engagement among older, rural‐dwelling adults living with HIV in the United States
Defining the Rural HIV Epidemic
Rural Aids Diagnoses in Florida
Geographic disparities in late HIV diagnoses in Tennessee
Patterns of Alcohol Use Among Patients Living With HIV in Urban, Large Rural, and Small Rural Areas
Health Care Avoidance Among Rural Populations
Rural and Urban Hispanic Patients of the Veterans Health Administration
Stigma, isolation and depression among older adults living with HIV in rural areas
Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy
Barriers to care among persons living with HIV/Aids in urban and rural areas
Associations of Rural Residence With Timing of HIV Diagnosis and Stage of Disease at Diagnosis, South Carolina 2001-2005
Where to Seek Care
The Social/Sexual Environment of Gay Men Residing in a Rural Frontier State
Rural Definitions for Health Policy and Research
Development and Verification of a “Virtual” Cohort Using the National VA Health Information System
Comparison of Two VA Laboratory Data Repositories Indicates That Missing Data Vary Despite Originating From the Same Source
Delayed Presentation for Human Immunodeficiency Virus (HIV) Care Among Veterans
Medical Disease and Alcohol Use Among Veterans With Human Immunodeficiency Infection
Short report
| Unique citing works | 21 |
|---|---|
| Citations per year | 1,4 |
| Citation span | 2011 - 2024 (14) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 21 |