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Related Experiment Video

Updated: Feb 26, 2026

Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty
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Insurance status and mortality among patients with AIDS.

A W Jabs1, D A Jabs1,2,3, M L Van Natta1

  • 1Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.

HIV Medicine
|July 12, 2017
PubMed
Summary

Patients with AIDS on combination antiretroviral therapy (cART) with public health insurance (Medicare/Medicaid) faced higher mortality risks compared to those with private insurance. This increased risk may stem from a greater prevalence of age-related diseases in publicly insured individuals.

Keywords:
AIDShealth insurancemortality

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Area of Science:

  • Public health
  • Epidemiology
  • HIV/AIDS research

Background:

  • Modern combination antiretroviral therapy (cART) has transformed HIV/AIDS management.
  • Understanding mortality risk factors in the cART era is crucial for patient outcomes.
  • Health insurance status is a potential determinant of healthcare access and outcomes for patients with AIDS.

Purpose of the Study:

  • To investigate the association between health care insurance status and mortality risk in patients with AIDS receiving cART.
  • To identify specific insurance types (private, Medicare, Medicaid, uninsured) linked to differential mortality.
  • To explore potential underlying reasons for observed disparities in mortality rates.

Main Methods:

  • Prospective, multicentre, observational study (Longitudinal Study of the Ocular Complications of AIDS - LSOCA).
  • Classification of patients based on health insurance: private, Medicare, Medicaid, or uninsured.
  • Utilized proportional hazards regression models with staggered entries to calculate adjusted hazard ratios (HRadj) for mortality.

Main Results:

  • Among 2363 participants with AIDS on cART, 16% were uninsured, 24% had Medicaid, 29% Medicare, and 31% private insurance.
  • Patients with Medicare showed significantly higher mortality risk (HRadj=1.35) compared to those with private insurance.
  • Increased mortality risks were also observed for Medicare and Medicaid recipients, particularly those with suppressed HIV viral load.

Conclusions:

  • Public insurance (Medicare, Medicaid) is associated with increased mortality in patients with AIDS compared to private insurance.
  • A higher burden of noninfectious, age-related diseases may contribute to the elevated mortality risk in publicly insured individuals.
  • While initially uninsured patients showed no significant difference, they often acquired ART and insurance during follow-up, potentially mitigating long-term risks.