UC San Diego

Importance: In the United States (U.S.), HIV-related health disparities have been reported, particularly among communities of color where the incidence of new HIV cases has been higher. However, it is unclear if disparities exist across different socioeconomic demographics, and whether they are associated with healthcare expenditures.Objectives: To evaluate the association between HIV status and healthcare expenditures, and assess the effect modification of socioeconomic factors on healthcare expenditures among people living with HIV (PLHIV) in the U.S. Methods: Using the Medical Expenditure Panel Survey (MEPS) database from 2011 to 2020, our study employed a serial cross-sectional design to compare total healthcare expenditures of adult household respondents aged ≥ 18 years with and without an HIV diagnosis. We used generalized linear models to estimate the marginal effects of socioeconomic factors on healthcare expenditures adjusting for potential confounders. Results: PLHIV had significantly higher total health care expenditures ($35,363, p<0.001) compared to those living without HIV after adjusting for age, sex, race, ethnicity, education, poverty status, and insurance status. However, there were no statistically significant differences in the marginal effects between males and females for each poverty, race and education category. Conclusion: Consistent with the existing literature, there was a significant association between HIV status and total healthcare expenditures among PLHIV in the US from 2011 to 2020. Future research should explore other factors such as the added burden of comorbidities and income inequality that could drive higher direct medical costs among PLHIV in our country.