Moving for care: findings from the US HIV cost and services utilization Study

Abstract

This paper examines sociodemographic and HIV-related factors associated with moving post-HIV diagnosis for non-care- and care-related reasons (versus never moving post-HIV diagnosis). Distinctions are made between those who move for informal care only, formal care only, or informal and formal care. Data come from the nationally representative US HIV Cost and Services Utilization Study (N=2,864). Overall, 31.8% moved at least once post-HIV diagnosis and 16.3% moved most recently for care. Among those who moved for care, 32.6% moved for informal care only, 26.8% for formal care only, and 40.6% moved for both. Post-HIV diagnosis moves for reasons unrelated to care were less likely among African Americans and older persons, and more likely among those with longer durations positive. Moves for care were less likely among African Americans, older persons, and persons with higher educational attainments, while they were more likely among those with an AIDS diagnosis and longer durations HIV-positive. Among those who moved for care, women and persons with higher incomes were less likely to move for formal or mixed care than informal care only. Given that moving for care may reflect disparities in access to care and unmet needs, additional analyses with more detailed data are warranted.

Acknowledgments

Earlier versions of this paper were presented at the Initiative in Population Research Colloquium, Ohio State University, Columbus, OH, 19 February 2002, and the annual meeting of the Population Association of America, Minneapolis, MN, 1–3 May 2003. The HCSUS was conducted under cooperative agreement U-01HS08578 (Martin F. Shapiro, PI; Samuel A. Bozzette, Co-PI) between RAND and the Agency for Healthcare Research and Quality. Substantial additional funding for this cooperative agreement was provided by the Health Resources and Services Administration, the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institutes of Health Office of Research on Minority Health through the National Institute of Dental Research. Additional support was provided by the Robert Wood Johnson Foundation, Merck and Company, Glaxo-Wellcome, Inc., the National Institute on Aging, and the Office of the Assistant Secretary for Planning and Evaluation in the US Department of Health and Human Services. The views expressed in this paper are those of the authors. No official endorsement by the Department of Health and Human Services or the Agency for Healthcare Research and Quality should be inferred.

Notes

Throughout the remainder of the text, we will use the term ‘post-HIV move’ instead of ‘most recent move post-HIV diagnosis’. However, the reader is encouraged to keep in mind that these reasons for moving are related to the most recent move.

A small number of respondents reported that they had been HIV-positive for 12 or more years. Since the HIV-antibody test was not widely available before 1985, it is likely that these reports reflect retrospective accounting of when symptoms first emerged or when other test results that were later construed as indicative of HIV infection were known.

More than one reason could be cited. Thus, percentages sum to more than 100%.

Consistent with this finding regarding the similarity between Hispanics and non-Hispanic whites, Brett et al. (1996) found no evidence to support the ‘air bridge’ hypothesis regarding migration from Puerto Rico to the mainland USA (primarily New York City) for care.

Our analysis is focused on examining the relative risks of undertaking different types of moves across subgroups of the population. Therefore, we discuss the RRRs that are derived from the multinomial logistic regression models we estimated and that are reported in the tables. However, the reader should note that RRRs are conceptually and mathematically distinct from risk ratios and should be interpreted as such. For example, the risk ratio of moving for care for women and men is equal to the probability of moving for care among women divided by the probability of moving for care among men. In contrast, the reported RRR presents the risk of moving for care versus not moving among women compared to the analogous ratio for men.

These RRRs should be interpreted with caution because they are based on a small number of respondents. The confidence intervals for moving for formal care only and mixed care are 5.800 to 179.523 and 2.225 to 98.879 respectively.