Comparing Cancer Incidence in an Observational Cohort of Medicaid Beneficiaries With and Without HIV, 2001-2015.
Journal
Journal of acquired immune deficiency syndromes (1999)
ISSN: 1944-7884
Titre abrégé: J Acquir Immune Defic Syndr
Pays: United States
ID NLM: 100892005
Informations de publication
Date de publication:
01 Jan 2024
01 Jan 2024
Historique:
received:
25
05
2023
accepted:
14
09
2023
medline:
7
12
2023
pubmed:
13
10
2023
entrez:
13
10
2023
Statut:
ppublish
Résumé
Life expectancy among people with HIV (PWH) is increasing, making chronic conditions-including cancer-increasingly relevant. Among PWH, cancer burden has shifted from AIDS-defining cancers (ADCs) toward non-AIDS-defining cancers (NADCs). We described incidence of cancer in a claims-based cohort of Medicaid beneficiaries. We included 43,426,043 Medicaid beneficiaries (180,058 with HIV) from 14 US states, aged 18-64, with >6 months of enrollment (with no dual enrollment in another insurance) and no evidence of a prveious cancer. We estimated cumulative incidence of site-specific cancers, NADCs, and ADCs, by baseline HIV status, using age as the time scale and accounting for death as a competing risk. We compared cumulative incidence across HIV status to estimate risk differences. We examined cancer incidence overall and by sex, race/ethnicity, and calendar period. PWH had a higher incidence of ADCs, infection-related NADCs, and death. For NADCs such as breast, prostate, and colon cancer, incidence was similar or higher among PWH below age 50, but higher among those without HIV by age 65. Incidence of lung and head and neck cancer was always higher for female beneficiaries with HIV, whereas the curves crossed for male beneficiaries. We saw only small differences in incidence trends by race/ethnicity. Our findings suggest an increased risk of certain NADCs at younger ages among PWH, even when compared against other Medicaid beneficiaries, and highlight the importance of monitoring PWH for ADCs and NADCs. Future work should explore possible mechanisms explaining the differences in incidence for specific cancer types.
Sections du résumé
BACKGROUND
BACKGROUND
Life expectancy among people with HIV (PWH) is increasing, making chronic conditions-including cancer-increasingly relevant. Among PWH, cancer burden has shifted from AIDS-defining cancers (ADCs) toward non-AIDS-defining cancers (NADCs).
SETTING
METHODS
We described incidence of cancer in a claims-based cohort of Medicaid beneficiaries. We included 43,426,043 Medicaid beneficiaries (180,058 with HIV) from 14 US states, aged 18-64, with >6 months of enrollment (with no dual enrollment in another insurance) and no evidence of a prveious cancer.
METHODS
METHODS
We estimated cumulative incidence of site-specific cancers, NADCs, and ADCs, by baseline HIV status, using age as the time scale and accounting for death as a competing risk. We compared cumulative incidence across HIV status to estimate risk differences. We examined cancer incidence overall and by sex, race/ethnicity, and calendar period.
RESULTS
RESULTS
PWH had a higher incidence of ADCs, infection-related NADCs, and death. For NADCs such as breast, prostate, and colon cancer, incidence was similar or higher among PWH below age 50, but higher among those without HIV by age 65. Incidence of lung and head and neck cancer was always higher for female beneficiaries with HIV, whereas the curves crossed for male beneficiaries. We saw only small differences in incidence trends by race/ethnicity.
CONCLUSION
CONCLUSIONS
Our findings suggest an increased risk of certain NADCs at younger ages among PWH, even when compared against other Medicaid beneficiaries, and highlight the importance of monitoring PWH for ADCs and NADCs. Future work should explore possible mechanisms explaining the differences in incidence for specific cancer types.
Identifiants
pubmed: 37831615
doi: 10.1097/QAI.0000000000003318
pii: 00126334-990000000-00311
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
26-34Subventions
Organisme : NIAID NIH HHS
ID : U01 AI069918
Pays : United States
Organisme : NIH HHS
ID : R01 CA250851
Pays : United States
Organisme : NIH HHS
ID : U01 AI069918
Pays : United States
Organisme : NIH HHS
ID : P30 CA006973
Pays : United States
Organisme : NIH HHS
ID : T32 CA0093140
Pays : United States
Organisme : NIH HHS
ID : P30 AI094189
Pays : United States
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
Références
Edwards JK, Cole SR, Breger TL, et al. Mortality among persons entering HIV care compared with the general U.S. population: an observational study. Ann Intern Med. 2021;174:1197–1206.
Samji H, Cescon A, Hogg RS, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013;8:e81355.
Shiels MS, Islam JY, Rosenberg PS, et al. Projected cancer incidence rates and burden of incident cancer cases in HIV-infected adults in the United States through 2030. Ann Intern Med. 2018;168:866–873.
Coghill AE, Engels EA, Schymura MJ, et al. Risk of breast, prostate, and colorectal cancer diagnoses among HIV-infected individuals in the United States. J Natl Cancer Inst. 2018;110:959–966.
Adih WK, Selik RM, Hall HI, et al. Associations and trends in cause-specific rates of death among persons reported with HIV infection, 23 U.S. Jurisdictions, through 2011. Open AIDS J. 2016;10:144–157.
Smith CJ, Ryom L, Weber R, et al. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet. 2014;384:241–248.
Rositch AF, Jiang S, Coghill AE, et al. Disparities and determinants of cancer treatment in elderly Americans living with human immunodeficiency virus/AIDS. Clin Infect Dis. 2018;67:1904–1911.
Burchell AN, Raboud J, Donelle J, et al. Cause-specific mortality among HIV-infected people in Ontario, 1995-2014: a population-based retrospective cohort study. CMAJ Open. 2019;7:E1–E7.
Croxford S, Kitching A, Desai S, et al. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort. Lancet Public Health. 2017;2:e35–e46.
Nishijima T, Inaba Y, Kawasaki Y, et al. Mortality and causes of death in people living with HIV in the era of combination antiretroviral therapy compared with the general population in Japan. AIDS. 2020;34:913–921.
Sellier P, Hamet G, Brun A, et al. Mortality of people living with HIV in Paris area from 2011 to 2015. AIDS Res Hum Retroviruses. 2020;36:373–380.
Coghill AE, Shiels MS, Suneja G, et al. Elevated cancer-specific mortality among HIV-infected patients in the United States. J Clin Oncol. 2015;33:2376–2383.
Coghill AE, Han X, Suneja G, et al. Advanced stage at diagnosis and elevated mortality among US patients with cancer infected with HIV in the National Cancer Data Base. Cancer. 2019;125:2868–2876.
Coghill AE, Suneja G, Rositch AF, et al. HIV infection, cancer treatment regimens, and cancer outcomes among elderly adults in the United States. JAMA Oncol. 2019;5:e191742.
Roberts T. Mar 27 PCP, 2023. Medicaid and People With HIV. KFF. Published March 27, 2023. Available at: https://www.kff.org/hivaids/issue-brief/medicaid-and-people-with-hiv/ . Accessed April 18, 2023.
Islami F, Guerra CE, Minihan A, et al. American Cancer Society's report on the status of cancer disparities in the United States, 2021. CA Cancer J Clin. 2022;72:112–143.
Gange SJ, Kitahata MM, Saag MS, et al. Cohort profile: the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Int J Epidemiol. 2007;36:294–301.
Institute of Medicine (US) Committee on the Consequences of Uninsurance. Health Insurance is a Family Matter. Washington, DC: National Academies Press (US); 2002. B, Overview of Public Health Insurance Programs. Available at: https://www.ncbi.nlm.nih.gov/books/NBK221009/ . Accessed August 29, 2023.
Medicaid. Seniors & Medicare and Medicaid Enrollees. Available at: https://www.medicaid.gov/medicaid/eligibility/seniors-medicare-and-medicaid-enrollees/index.html . Accessed August 29, 2023.
Fultz SL, Skanderson M, Mole LA, et al. Development and verification of a “virtual” cohort using the national VA health information system. Med Care. 2006;44:S25–S30.
Keller SC, Momplaisir F, Lo Re V, et al. Colorectal cancer incidence and screening in US Medicaid patients with and without HIV infection. AIDS Care. 2014;26:716–722.
Condition Categories. Chronic Conditions Data Warehouse. Available at: https://www2.ccwdata.org/condition-categories . Accessed August 25, 2021.
Silverberg MJ, Chao C, Leyden WA, et al. HIV infection and the risk of cancers with and without a known infectious cause. AIDS. 2009;23:2337–2345.
Lesko CR, Fox MP, Edwards JK. A framework for descriptive epidemiology. Am J Epidemiol. 2022;191:2063–2070.
Aalen OO, Johansen S. An empirical transition matrix for non-homogeneous Markov chains based on censored observations. Scand J Stat. 1978;5:141–150.
Andersen PK, Geskus RB, de Witte T, et al. Competing risks in epidemiology: possibilities and pitfalls. Int J Epidemiol. 2012;41:861–870.
Silverberg MJ, Lau B, Achenbach CJ, et al. Cumulative incidence of cancer among persons with HIV in North America: a cohort study. Ann Intern Med. 2015;163:507–518.
Benefits. MACPAC. Available at: https://www.macpac.gov/medicaid-101/benefits/ . Accessed April 18, 2023.
Chiao EY, Coghill A, Kizub D, et al. The effect of non-AIDS-defining cancers on people living with HIV. Lancet Oncol. 2021;22:e240–e253.
Haas CB, Engels EA, Horner MJ, et al. Trends and risk of lung cancer among people living with HIV in the USA: a population-based registry linkage study. Lancet HIV. 2022;9:e700–e708.
CDC. What are the Risk Factors for Lung Cancer? Published October 26, 2022. Available at: https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm . Accessed April 18, 2023.
Asfar T, Perez A, Shipman P, et al. National estimates of prevalence, time-trend, and correlates of smoking in US people living with HIV (NHANES 1999-2016). Nicotine Tob Res official J Soc Res Nicotine Tob. 2021;23:1308–1317.
NCI. Head and Neck Cancers. Published June 9, 2021. Available at: https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet . Accessed April 18, 2023.
Ye Y, Burkholder GA, Wiener HW, et al. Comorbidities associated with HPV infection among people living with HIV-1 in the southeastern US: a retrospective clinical cohort study. BMC Infect Dis. 2020;20:144.
Corcorran MA, Kim N. Chronic hepatitis B and HIV coinfection. Top Antivir Med. 2023;31:14–22.
Hepatitis C Virus | NIH. Published January 18, 2023. Available at: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/hepatitis-c-virus . Accessed July 20, 2023.
Hernández-Ramírez RU, Shiels MS, Dubrow R, et al. Cancer risk in HIV-infected people in the USA from 1996 to 2012: a population-based, registry-linkage study. Lancet HIV. 2017;4:e495–e504.
Silverberg MJ, Leyden W, Hernández-Ramírez RU, et al. Timing of antiretroviral therapy initiation and risk of cancer among persons living with human immunodeficiency virus. Clin Infect Dis Off Publ Infect Dis Soc Am. 2021;72:1900–1909.
Yehia BR, Stephens-Shields AJ, Fleishman JA, et al. The HIV care continuum: changes over time in retention in care and viral suppression. PLoS One. 2015;10:e0129376.
Oral Cavity & Oropharyngeal Cancer Key Statistics 2021. Available at: https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/key-statistics.html . Accessed January 6, 2023.
Crum-Cianflone N, Hullsiek KH, Marconi V, et al. Trends in the incidence of cancers among HIV-infected persons and the impact of antiretroviral therapy: a 20-year cohort study. AIDS. 2009;23:41–50.
NCI. About Rare Cancers. Published February 27, 2019. Available at: https://www.cancer.gov/pediatric-adult-rare-tumor/rare-tumors/about-rare-cancers . Accessed December 12, 2022.