Author

Erin Fennern

Date

6-2015

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health & Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Background: Obesity is a common medical condition that may be associated with disparities in healthcare quality.

Objective: Assess for differences in quality of care provided to HIV-infected patients by body mass index (BMI) category.

Design: Cross-sectional analyses of patients followed longitudinally. Data on 9 HIV quality indicators (QIs) were abstracted from patient medical records. BMIs were categorized as normal (18.5 to 24.9), overweight (25 to 29.9), stage 1 obese (30 to 34.9), stage 2 obese (35 to 39.9), and stage 3 obese (≥ 40).

Participants: 6,031 patients (10,896 total observations) age ≥18 years, engaged in care (i.e. ≥ 2 clinic visits per year) at 7 clinics in the HIV Research Network from years 2007 to 2010. Main Measures: We used multivariate logistic regression to examine associations between BMI and receipt of each QI, and multivariate linear regression to examine the association between BMI and the mean percent of eligible QIs received.

Key Results: Patients received a mean of 65% of eligible QIs. Those with BMIs ≥40 received slightly less than normal weight patients (adjusted mean difference of -4%; 95% CI -6% to -2%). This group received slightly less screening for hepatitis C (HCV; aOR = 0.73, 95% CI 0.55 to 0.98), gonorrhea/Chlamydia (aOR = 0.76, 95% CI 0.60 to 0.96), and syphilis (aOR = 0.69, 95% CI 0.56 to 0.86), but more CD4 counts (aOR = 1.44, 95% CI 1.07 to 1.95), relative to normal weight patients.

Conclusions: The mean percent of eligible QIs received varied little in absolute differences across BMI categories. Providers prescribed anti-retroviral therapy (ART) regardless of BMI, but performed less HCV and sexually transmitted infection (STI) screening as BMI increased, suggesting prioritization of some QIs over others in high BMI patients.

Identifier

doi:10.6083/M4GM862S

School

School of Medicine

Included in

Public Health Commons

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