Excess prevalence of cancer in Medicaid beneficiaries with HIV

Authors: Koroukian SM, Zhou G, Navale S, Schiltz NK, Rose, J, Owusu C, Cooper G, Moore S, Markt, S, Statler A, Mukherjee S, Mintz L, Avery A, Zanotti K.

Category: Cancer Health Disparities
Conference Year: 2020

Abstract Body:
Purpose: To quantify the excess prevalence of cancer among Medicaid beneficiaries by HIV status. Methods: This was a cross-sectional study using data from the 2012 Medicaid Analytic eXtract (MAX) files for all 50 states. We limited our study population to individuals 18-64 years of age. We identified HIV status and cancers (in total, and by anatomic cancer site) from the relevant diagnosis codes in claims data. We obtained demographic data (age, race, and sex) from the enrollment file. In addition to reporting the crude cancer prevalence rates, we conducted multivariable logistic regression models to assess excess cancer prevalence by HIV status, adjusting for age, race, and sex (where applicable). Results: Our study included 27.9 million individuals, of whom 156,199 (0.6%) were persons living with HIV (PLwHIV). Compared with their HIV-free counterparts, a greater percentage of PLwHIV were men (53.6% vs. 32.0%), Black (53.1% vs. 21.2%), and 35 years of age or older (76.1% vs. 39.8%). For all cancers combined, the prevalence rate was 69.6 per 1,000 among PLwHIV and 23.4 per 1,000 in their non-HIV counterparts, and this pattern persisted for all cancers with the exception of female breast and prostate cancers. For all cancers combined, the adjusted odds ratio (AOR) for HIV status was 2.69 (95% confidence interval: 2.64, 2.75). AORs were highest for anal cancer (64.7 (60.7, 69.1)), leukemia/lymphoma (5.7 (5.5, 6.0)), cervical cancer (4.0 (3.9, 4.2)), liver and intrahepatic bile duct (2.8 (2.5, 3.1)), rectal cancer (2.8 (2.6, 3.1)), lung and bronchus (1.9 (1.8, 2.1)) and head neck cancer (1.7 (1.6, 1.9)). Conclusions: In a first national Medicaid study, we documented a significantly higher burden of cancer in PLwHIV compared with their HIV-free counterparts, even for non-AIDS defining cancers. The intersectionality of HIV, being a person of color, and Medicaid status implies a heightened level of vulnerability to compromised access to care and poor outcomes. Future studies should explore disparities across more granular cancer site subcategories and identify specific points along the cancer care continuum where opportunities may exist to improve prevention and timely access to appropriate treatment.

Keywords: Cancer Burden; HIV; Medicaid; non-AIDS Defining Cancers