Objective: To evaluate the effect of human immunodeficiency virus (HIV) infection and tuberculosis on hospitalizations and the cost of care.
Design: National Hospital Discharge Survey, a nationally representative survey of discharges from U.S. nonfederal short-stay hospitals, and statewide billing information.
Patients: Patients 15 to 44 years of age with a listed diagnosis of HIV infection (n = 418 200) or active tuberculosis (n = 77 700) during 1985-1990.
Results: During 1985-1990, hospitalizations related to HIV infection increased sixfold, from 18 to 102 per 100 000 persons; during 1988-1990, hospitalizations related to tuberculosis increased twofold, from 8 to 16 per 100 000 persons. The prevalence of tuberculosis among HIV-infected patients increased from 2.4% in 1985-1988 to 5.1% in 1989-1990 (P = 0.003). The prevalence of HIV infection among patients with tuberculosis increased from 11% in 1985-1988 to 28% in 1989 to 39% in 1990 (P < 0.001). Infection with HIV was more prevalent among patients with extrapulmonary tuberculosis (31%) than among those with pulmonary tuberculosis (18%) (P = 0.01). An increase in the duration of hospital stay was associated with both tuberculosis and HIV infection. From 1985 to 1990, inpatient care costs increased 7.7-fold and 3.2-fold for HIV and tuberculosis hospitalizations, respectively. During this period, HIV and tuberculosis hospitalizations resulted in 5 793 000 and 1 107 900 days of care, respectively, with an estimated direct cost of $5.7 to $7.4 billion and $0.89 to $1.07 billion, respectively. Estimated national costs of inpatient care for HIV infection or tuberculosis or both totaled $6.4 to $8.1 billion, 5% of which was for patients with both HIV infection and tuberculosis.
Conclusions: This is the first study to use a nationally representative sample of hospitals, combined with cost data, to estimate hospitalizations and their costs for HIV and tuberculosis care. Our findings suggest that the convergence of the HIV and tuberculosis epidemics has had an increasing effect on morbidity and the cost of care among young adults in the United States. The increasing prevalence of comorbidity of HIV infection and tuberculosis in inpatients underscores the need for strict infection control of tuberculosis on the part of hospitals, increased attention to prevention, and early identification and treatment of HIV infection and tuberculosis to reduce morbidity, hospitalizations, and the cost of care.