Hospital length of stay and cost burden of HIV, tuberculosis, and HIV-tuberculosis coinfection among pregnant women in the United States

Published:November 03, 2017DOI:


      • From 2002-2014, HIV, tuberculosis (TB), and HIV-TB coinfection rates have declined among pregnant women.
      • Mean hospital length of stay is higher in HIV-TB coinfected mothers than those who are HIV- or TB-free.
      • Hospital costs are amplified for mothers with active TB or HIV-TB coinfection.


      We sought to determine hospital length of stay (LOS) and cost burden associated with hospital admissions among pregnant women with HIV monoinfection, tuberculosis (TB) monoinfection, or HIV-TB coinfection in the United States.


      Analysis covered the period from 2002-2014 using data from the Nationwide Inpatient Sample. Relevant ICD-9-CM codes were used to determine HIV and TB status. Costs associated with hospitalization were calculated and adjusted to 2010 dollars using the medical care component of the Consumer Price Index.


      We found modest annual average reduction in HIV, TB, and HIV-TB coinfection rates over the study period. The mean LOS was lowest among mothers free of HIV or TB disease and highest among those with HIV-TB coinfection. The average LOS among mothers diagnosed with TB monoinfection was 60% higher than for those with HIV monoinfection. The cost associated with pregnancy-related hospital admissions among mothers with HIV was approximately 30% higher than disease-free mothers, and the cost more than doubled among patients with TB monoinfection or HIV-TB coinfection.


      TB significantly increased hospital care cost among HIV-positive and HIV-negative pregnant women.

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        • Sugarman J.
        • Colvin C.
        • Moran A.C.
        • Oxlade O.
        Tuberculosis in pregnancy: an estimate of the global burden of disease.
        Lancet Glob Health. 2014; 2: e710-e716
        • UNAIDS
        2006 report on the global AIDS epidemic.
        (Available from:)
        Date: 2006
        Date accessed: July 1, 2010
        • World Health Organization
        2007 tuberculosis facts.
        (Available from:)
        • U.S. Agency for International Development
        The twin epidemics: HIV and TB coinfection.
        (Available from:)
        • Schneider E.
        • Castro K.G.
        Tuberculosis trends in the United States, 1992-2001.
        Tuberculosis (Edinb). 2003; 83: 21-29
        • World Health Organization
        Global tuberculosis report 2015.
        (Available from:)
        Date: 2015
        Date accessed: April 4, 2017
        • Salinas J.L.
        • Mindra G.
        • Haddad M.B.
        • Pratt R.
        • Price S.F.
        • Langer A.J.
        Leveling of tuberculosis incidence—United States, 2013-2015.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 273-278
        • El-Messidi A.
        • Czuzoj-Shulman N.
        • Spence A.R.
        • Abenhaim H.A.
        Medical and obstetric outcomes among pregnant women with tuberculosis: a population-based study of 7.8 million births.
        Am J Obstet Gynecol. 2016; 215: 797.e1-797.e6
        • Healthcare Cost and Utilization Project (HCUP)
        Introduction to the HCUP Nationwide Inpatient Sample (NIS) 2011.
        (Available from:)
        • Salemi J.L.
        • Salihu H.M.
        The prevalence of active tuberculosis infection among pregnant women is not increasing in the United States.
        Am J Obstet Gynecol. 2017; 217: 490-491
        • Kim H.J.
        • Fay M.P.
        • Feuer E.J.
        • Midthune D.N.
        Permutation tests for joinpoint regression with applications to cancer rates.
        Stat Med. 2000; 19: 335-351
        • National Cancer Institute
        Joinpoint regression program, version, statistical methodology and applications branch, surveillance research program.
        (Available from:)
        Date: 2016
        Date accessed: January 4, 2015
        • Houchens R.L.
        • Elixhauser A.
        Using the HCUP nationwide inpatient sample to estimate trends (updated for 1988-2004).
        (HCUP methods series Report # 2006-05 online; Available from:)
        • World Health Organization.
        Global tuberculosis report 2016.
        (Available from:)
        Date: 2016
        Date accessed: April 4, 2017
        • Hesseling A.C.
        • Rabie H.
        Tuberculosis and HIV remain major causes of death in African children.
        Int J Tuberc Lung Dis. 2016; 20: 996-997
        • Ribeiro P.S.
        • Jacobsen K.H.
        • Mathers C.D.
        • Garcia-Moreno C.
        Priorities for women's health from the Global Burden of Disease study.
        Int J Gynaecol Obstet. 2008; 102: 82-90
        • Holmquist L.
        • Russo C.A.
        • Elixhauser A.
        Tuberculosis stays in U.S. hospitals, 2006.
        Agency for Healthcare Research and Quality, Rockville (MD)2008
        • Girardi E.
        • Sabin C.A.
        • d'Arminio Monforte A.
        • Hogg B.
        • Phillips A.N.
        • Gill M.J.
        • et al.
        Incidence of tuberculosis among HIV-infected patients receiving highly active antiretroviral therapy in Europe and North America.
        Clin Infect Dis. 2005; 41: 1772-1782
        • Sutherland J.S.
        • Young J.M.
        • Peterson K.L.
        • Sanneh B.
        • Whittle H.C.
        • Rowland-Jones S.L.
        • et al.
        Polyfunctional CD4(+) and CD8(+) T cell responses to tuberculosis antigens in HIV-1-infected patients before and after anti-retroviral treatment.
        J Immunol. 2010; 184: 6537-6544
        • Grabmeier-Pfistershammer K.
        • Steinberger P.
        • Rieger A.
        • Leitner J.
        • Kohrgruber N.
        Identification of PD-1 as a unique marker for failing immune reconstitution in HIV-1-infected patients on treatment.
        J Acquir Immune Defic Syndr. 2011; 56: 118-124
        • Lederman M.M.
        • Calabrese L.
        • Funderburg N.T.
        • Clagett B.
        • Medvik K.
        • Bonilla H.
        • et al.
        Immunologic failure despite suppressive antiretroviral therapy is related to activation and turnover of memory CD4 cells.
        J Infect Dis. 2011; 204: 1217-1226
        • Vivar N.
        • Ruffin N.
        • Sammicheli S.
        • Hejdeman B.
        • Rethi B.
        • Chiodi F.
        Survival and proliferation of CD28- T cells during HIV-1 infection relate to the amplitude of viral replication.
        J Infect Dis. 2011; 203: 1658-1667
        • Johnson A.S.
        • Hall H.I.
        • Hu X.
        • Lansky A.
        • Holtgrave D.R.
        • Mermin J.
        Trends in diagnoses of HIV infection in the United States, 2002-2011.
        JAMA. 2014; 312: 432-434
        • Hill A.N.
        • Becerra J.
        • Castro K.G.
        Modelling tuberculosis trends in the USA.
        Epidemiol Infect. 2012; 140: 1862-1872
        • Nnadi C.D.
        • Anderson L.F.
        • Armstrong L.R.
        • Stagg H.R.
        • Pedrazzoli D.
        • Pratt R.
        • et al.
        Mind the gap: TB trends in the USA and the UK, 2000-2011.
        Thorax. 2016; 71: 356-363
        • Schmit K.M.
        • Wansaula Z.
        • Pratt R.
        • Price S.F.
        • Langer A.J.
        Tuberculosis - United States, 2016.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 289-294
        • Centers for Disease Control and Prevention
        A strategic plan for the elimination of tuberculosis in the United States.
        MMWR Morb Mortal Wkly Rep. 1989; 38: 269-272
        • Reves R.R.
        • Nolan C.M.
        Tuberculosis elimination in the United States: an achievable goal or an illusion?.
        Am J Respir Crit Care Med. 2012; 186: i-iii