Mental Health Status and Healthcare Utilization Inequity Among People Living With HIV: A Cross-Sectional Study Using Inverse Probability Treatment Weighting.
Psychological distress is highly prevalent among people living with HIV (PLHIV) and may impact healthcare utilization patterns. However, the relationship between mental health status and healthcare utilization inequity in this population remains poorly understood, particularly in resource-limited settings. This study aimed to examine the association between mental health status and healthcare utilization inequity among PLHIV using robust methodological approaches.
This cross-sectional study included 418 PLHIV receiving antiretroviral therapy (ART) at major HIV treatment centers in southwestern China. Mental health status was assessed using validated Chinese versions of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales. Healthcare utilization measures included self-rated health (SRH), 2-week morbidity, chronic disease prevalence, and hospitalization rates. Inverse probability treatment weighting (IPTW) was employed to minimize confounding, and concentration indices (CIs) were calculated to assess healthcare utilization inequity. Decomposition analysis identified key contributors to observed inequities.
After IPTW adjustment, participants who were symptom-positive (48.3%) demonstrated significantly poorer health outcomes compared to those who were symptom-negative (51.7%). The symptom-positive group showed higher rates of poor SRH (52.6% vs. 37.5%;p < 0.110), 2-week morbidity (56.7% vs. 47.6%; p = 0.010), and chronic disease (49.0% vs. 41.6%;p = 0.030). Paradoxically, despite worse health status, this group had lower hospitalization rates (82.1% vs. 88.2%;p = 0.010). CIs revealed pro-rich inequities across all outcomes, with particularly pronounced disparities in hospitalization (CI = -0.2379,). Decomposition analysis identified drug use history (-1.1×101%, p < 0.001), physical activity patterns (1.4×100%, p = 0.0099), and health record establishment (3.1×100%, p < 0.001) as key contributors to healthcare utilization inequities.
PLHIV with symptom-positive experience significant disparities in health outcomes and healthcare utilization, characterized by poorer health status but lower healthcare service utilization. While pro-rich inequities exist across all outcomes, the patterns and magnitude of these inequities differ for symptom-positive individuals compared to their counterparts. These findings highlight the need for integrated mental health and HIV services, systematic healthcare management, and targeted interventions to address healthcare barriers in this vulnerable population.
This cross-sectional study included 418 PLHIV receiving antiretroviral therapy (ART) at major HIV treatment centers in southwestern China. Mental health status was assessed using validated Chinese versions of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales. Healthcare utilization measures included self-rated health (SRH), 2-week morbidity, chronic disease prevalence, and hospitalization rates. Inverse probability treatment weighting (IPTW) was employed to minimize confounding, and concentration indices (CIs) were calculated to assess healthcare utilization inequity. Decomposition analysis identified key contributors to observed inequities.
After IPTW adjustment, participants who were symptom-positive (48.3%) demonstrated significantly poorer health outcomes compared to those who were symptom-negative (51.7%). The symptom-positive group showed higher rates of poor SRH (52.6% vs. 37.5%;p < 0.110), 2-week morbidity (56.7% vs. 47.6%; p = 0.010), and chronic disease (49.0% vs. 41.6%;p = 0.030). Paradoxically, despite worse health status, this group had lower hospitalization rates (82.1% vs. 88.2%;p = 0.010). CIs revealed pro-rich inequities across all outcomes, with particularly pronounced disparities in hospitalization (CI = -0.2379,). Decomposition analysis identified drug use history (-1.1×101%, p < 0.001), physical activity patterns (1.4×100%, p = 0.0099), and health record establishment (3.1×100%, p < 0.001) as key contributors to healthcare utilization inequities.
PLHIV with symptom-positive experience significant disparities in health outcomes and healthcare utilization, characterized by poorer health status but lower healthcare service utilization. While pro-rich inequities exist across all outcomes, the patterns and magnitude of these inequities differ for symptom-positive individuals compared to their counterparts. These findings highlight the need for integrated mental health and HIV services, systematic healthcare management, and targeted interventions to address healthcare barriers in this vulnerable population.
Authors
Ma Ma, Xiao Xiao, Chen Chen, Li Li, Ding Ding, Chen Chen, Chen Chen, Chen Chen, Huang Huang, Li Li, Fan Fan
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