Background: Although 30-day hospital readmission is a widely followed quality measure, there are limited US nationwide data to evaluate its trends among people with HIV (PWH) and the sex disparity over time. We describe the 30-day all-cause unplanned readmission trends among PWH and people without HIV (PWoH) in the US.

Setting: Adult participants in the 2010-2020 Nationwide Readmissions Database(NRD), which weighted represents all US hospitalizations each year.

Methods: We defined index admission and unplanned readmission using the US Centers for Medicare & Medicaid Services criteria. Overall and sex-specific readmission risk were tabulated among the index admissions from adult PWH and PWoH each year in the 2010-2020 NRD. Random effect linear and Poisson regressions were used to estimate risk difference (RD) and annual percent change of the trend. We added a spline in 2015 and additionally stratified the analysis by age and patient’s zip code median household income. All analyses were weighted to generate national estimates.

Results: Approximately 140,000 index admissions from PWH and 25 million from PWoH were included each year. For PWoH between 2010-2020, annual readmission risk was stable at ∼12%. For PWH, readmission risk was stable at ∼22% during 2010-2015 and decreased from 22.0% in 2016 to 20.1% in 2020(RD= -1.60[-2.24,-0.95]). Non-pregnant female PWH continued to have higher readmission risk than male PWH for all subgroups and all years. Female PWH <40 years had no reduction in readmission risk between 2016-2020(RD= -0.45[-2.43,1.53]).

Conclusion: There remains strong need for readmission reduction interventions focusing on PWH, especially for young female PWH.