Exploring differences in violence and abuse-related healthcare utilization and mortality among people living with and without HIV in British Columbia, Canada

BACKGROUND: The syndemic of HIV and violence is well documented, however the impact of violence/abuse among people with HIV (PWH) on healthcare utilization (e.g., hospitalization) and survival is unclear. Limited research has explored how experiences of violence/abuse appear in administrative health data and how this differs by HIV status.This study seeks to characterize violence/abuse-related administrative health records and mortality among people with and without HIV in British Columbia (BC), Canada.
METHODS: The Comparative Outcomes and Services Utilization Trends (COAST) study is a population-based longitudinal cohort examining health outcomes and healthcare utilization of all PWH in BC and a randomly selected 10% general population comparison sample. We examined violence/abuse-related administrative health records (documented in practitioner [e.g., physicians, nurses] claims and hospitalization records, using abuse and assault-related ICD-9/ICD-9-CM [all practitioner claims; hospital data up until 2001]and ICD-10-CA [hospital data 2001-onward] codes) among people with (n=12,057) and without HIV (n=514,952) from April 1, 1996 to March 31,2013. We examined differences in the prevalence of violence/abuse (with, without HIV) in administrative health records and, for those who with violence/abuse-related records, differences in all-cause and cause-specific mortality.
RESULTS: Between 1996-2013, 5,668 (1.0%) participants in COAST had '¥1 occurrence of violence/abuse-related health record(s) (3.5% among PWH, and 1.0% among those without HIV).A quarter (124/493) of PWH with '¥1 violence/abuse-related record were female. Over the study period, 810 of the5,668 participantswho had a violence/abuse record died, including 33.9% and 12.4% of people with and without HIV, respectively. Among 167 PWH who died, the most common cause of death was HIV-related (38.3%), whereas 12.6% died from assault, homicide, or injury-related causes (compared to 28.8%, among people without HIV).
CONCLUSIONS: Findings revealed higher violence/abuse-related healthcare utilization among PWH (vs. without HIV), and although the proportion of deaths among patients who had violence/abuse health records was higher among PWH, less PWH died of homicides, assault, or injury-related causes. High levels of mortality and violence/abuse-related healthcare utilization among PWH highlightsthe physical and social risk envrionments PWH are in, andthe need to integrate monitoring and holistic violence prevention and support services within HIV/AIDS care.

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