Disparities in HIV-related hospitalizations for native Hawaiians and Asians compared to whites

background: Hospitalizations by those living with HIV are expensive and often indicate a failure in access to or retention in primary care. Asian Americans and Native Hawaiians are some of the fastest growing racial/ethnic groups in the US and many members of these groups face barriers in access to health care. Higher rates of HIV hospitalizations have been reported in some U.S. ethnic minorities, yet little information is available for Native Hawaiians and Asian subgroups. Evidence suggests that HIV-related hospitalization rates may be higher in these groups than in whites.

methods: All hospitalizations in Hawaii by individuals aged >18 years from Dec 2006–Dec 2010 were considered. HIV-related hospitalizations were identified using ICD-9 diagnosis codes of 042-044 and V08 on any diagnostic field. Using Hawaii State Department of Health 2010 data, rates of HIV-related hospitalizations by ethnicity among the 2,112 Hawaii residents living with HIV were estimated along with rate ratios (using whites as the reference group). Multivariable adjusted rate ratios (aRR) were calculated with negative binomial models, adjusting for age, gender and payer type.

results: Of the 210,770 patients hospitalized, 613 had an HIV-related hospitalization. Native Hawaiians (aRR: 3.21; 95%CI: 2.11-4.88), Japanese (aRR: 2.27; 95%CI: 1.38-3.72), and Filipinos (aRR: 1.62; 1.01-2.59) living with HIV all had higher likelihood of an HIV-related hospitalization compared to whites, even when controlling for age, gender and payer. Chinese did not vary significantly from whites. Also of note, the average age of those with an HIV-related hospitalization varied significantly across groups (p<0.001), with Native Hawaiians as the youngest (45 years), followed by Filipinos (47), whites (49), Chinese (50) and Japanese (54).

conclusions: Disparities exist in HIV-related hospitalizations for Native Hawaiians and Asian subgroups.  Of particular note, Native Hawaiians are hospitalized at significantly higher rates and at younger ages than other racial/ethnic groups in Hawaii. Many Asian American and Pacific Islanders face linguistic, economic and legal barriers to HIV prevention, testing, services, and ongoing care, which may contribute to these differences in HIV-related hospitalizations. Further research is warranted to investigate and resolve these health disparities.