SOEDAK2009 --- PREPARE FOR THE LONG RUN

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Titel
Clinical outcomes of HIV-positive patients (PLWHA) having different income status: results of an analysis on basis of the KompNet cohort
Autor
Klaus Jansen1, Norbert H. Brockmeyer1,2, Verena Dlugay3, Matthias Stoll4, Ramona Volkert5, Jörg Gölz6, Thomas Buhk7, Andreas Carganico8, Peter
Abstract
Issue of research/question: Income-status is assumed to be a highly influencing factor for health outcomes, generally. Reliable data on income status of PLWHA in Germany are rare, because gathering income-data is challenging, due to privacy of patients. To analyse this aspect for PLWHA in Germany, we evaluated income-data of the nationwide KompNet-cohort with regard to central clinical parameters.
Description: The cohort surveys income-data since 7/2007. By 8/2008, we received data for already 2.045 patients. There were nearly no differences between this subpopulation and the overall-cohort (N=6.085), comparing age, sex, risk of infection, origin, CDC-stage.
Of the subpopulation, 39.6% had an income < =1.000€, 48.1%=1001€-2.500€ and 12.3% >2.500€ (table 1). We observed a lower income structure in women, as well as in migrants. Significantly, we found a distinct poorer health outcome concerning CDC-stage and CD4-cell count, in relation to patient's income status: only 30.0% of patients having an income < =1.000€ were diagnosed as CDC-stage A (B:23.8%; C:43.0%), 60.4% of these patients had an CD4-cell-count < 200. Differences concerning viral load were slightly and not significantly.

    Income
(%) ≤ 1.000€ 1.001€ - 2.500€ >2.500€ p-value
All 39.6 48.1 12.3  
Sex       < 0.01
Men 38.1 48.5 13.4  
Women 48.7 45.2 6.1  
Migration status       < 0.01
non migrated 37.6 49.1 13.3  
migrated 52.5 41.3 6.2  
[Income structure, by sex and migration status]


    Income
(%) ≤ 1.000€ 1.001€ - 2.500€ > 2.500€ p-value
All 39.6 48.1 12.3  
CD4-cell-count       < 0.01
< 200 cells/μl 60.4 33.6 6.0  
200-499 cells/μl 40.4 48.4 11.2  
≥ 500 cells/μl 35.9 49.9 14.2  
Viral load < detection limit 67.7 70.3 71.0 0.41
[Income status, by CD4-cell-count and VL]


    Income
(%) ≤ 1.000€ 1.001€ - 2.500€ > 2.500€ p-value
All 39.6 48.1 12.3  
CDC-stage       < 0.01
A 30.0 55.0 15.0  
B 42.8 44.8 12.4  
C 43.0 47.3 9.7  
[Income structure, by CDC-stage]

Conclusion: Because the composition of the analysed subpopulation equalled the overall-cohort well, our preliminary data give already a good impression of income status, its sociodemographic impact and its influence on clinical outcomes for the KompNet cohort and therewith an approximation for PLWHA in Germany. The clearly poorer health outcomes for patients with lower income confirm results of studies on incomes status and general health outcomes and show a big need for better treatment and care for this group.
Next steps: Data completion has to be carried on. Deutsche AIDS-Stiftung (DAS) and KompNet are planning a study concerning clinical outcomes of PLWHA with low income. Respecting data protection, DAS- and KompNet-datasets will be combined, health parameters of DAS-clientel will be compared to that of KompNet-patients.
Datei SOEDAK_09_OSD5.pdf