Medicaid data as a complement to cohort studies for investigating cancers among older people with HIV

摘要 非艾滋病定义的癌症（NADC）预计占艾滋病患者所有癌症的89%。 到2030年，艾滋病毒（PLWH），绝大多数在老年PLWH中被诊断出来。这种转变令人担忧，因为， 据报道，与未感染艾滋病毒的人相比，艾滋病毒携带者在几种NADC中的癌症特异性死亡率更高， 和最常见NADC诊断后的较高总体死亡率。高死亡率的原因 在NADC后的PLWH中可能是多因素的，目前还没有完全理解。近似给出 45%的PLWH年龄在50岁以上，其中84%在50岁至64岁之间，了解这一交叉点至关重要 艾滋病病毒、NADC和健康老龄化之间的关系。为制定有效的NADC提供信息 预防和治疗策略的老龄化PLWH人口，重要的是能够解开 艾滋病病毒感染的社会行为因素的影响。为了做到这一点，一个比较组 在风险因素、社会经济地位和获得护理的负担相当的情况下，约 在美国，40%的PLWH由医疗补助覆盖。医疗补助受益人是一个多样化的人口，包括 具有相似风险因素负担和获得护理的PLWH对照组。医疗补助人口是 这是对现有艾滋病毒资源的重要补充，包括那些（1）捕获癌症发病率，但 下游事件，如艾滋病毒-癌症匹配队列，（2）包括丰富的队列数据，但有限 特定类型的癌症病例，以允许检查种族和性别差异，如NA-ACCORD，以及（3） 其他基于索赔的队列，这些队列捕获了艾滋病毒和普通人群中重要但不同的部分， 包括SEER医疗保险。我们建议评估超过500万医疗补助受益人的索赔， 2001年至2017年期间，在现代抗逆转录病毒治疗时代，来自14个州的10岁以下儿童：（1）量化 PLWH中癌症类型的NADC的年龄、种族/民族和性别特异性发病率（2）评估了 HIV感染与NADC特异性治疗相关结局之间的相关性，（3）评估 NADC特异性诊断与新的艾滋病定义疾病和艾滋病毒护理保留之间的关系，以及（4）评估 根据癌症类型，HIV和NADC的诊断是否与年龄相关的高风险相关， 与单独诊断HIV或NADC的结果相比。这项研究的结果将告诉人们， 艾滋病毒的存在会影响非艾滋病定义的癌症的风险和后果，并影响艾滋病毒护理 和老年人的年龄相关结果。重要的是，我们将在低收入， 50岁以上男性和女性的不同人群与具有可比风险因素的比较人群 和获得医疗的机会。

ABSTRACT Non-AIDS defining cancers (NADCs) are projected to account for 89% of all cancers among people living with HIV (PLWH) by 2030, with the vast majority diagnosed among older PLWH. This shift is concerning because, as compared to people without HIV, PLWH reportedly have higher cancer-specific mortality for several NADCs, and higher overall mortality after diagnosis of the most common NADCs. The explanation for higher mortality among PLWH after a NADC is likely multifactorial and, at present, not fully understood. Given approximately 45% of PLWH are 50 years, with 84% of those between 50 and 64, it is critical to understand the intersection between HIV, NADCs, and healthy aging in this population. To inform the development of effective NADC prevention and treatment strategies for the aging PLWH population, it is important to be able to disentangle the influence of HIV from the socio-behavioral factors associated HIV acquisition. To do this, a comparison group with a comparable burden of risk factors, socioeconomic status, and access to care is needed. Approximately 40% of PLWH in the US are covered by Medicaid. Medicaid beneficiaries are a diverse population, and include a comparison group for PLWH with similar risk factor burden and access to care. The Medicaid population is an important complement to existing HIV resources, including those that (1) capture cancer incidence but not downstream events, such as the HIV-Cancer Match cohort, (2) include rich cohort data, but have limited specific types of cancer cases to allow for examining race and sex differences, like the NA-ACCORD, and (3) other claims-based cohorts which capture, important, but different segments of the HIV and general population, including SEER-Medicare. We propose to assess claims for more than 5 million Medicaid beneficiaries 50 years old from 14 states between 2001 and 2017, in the modern era of antiretroviral therapy, to: (1) quantify the age-, race/ethnicity-, and sex- specific incidence of NADCs by cancer type among PLWH (2) evaluate the association between HIV-infection and NADC-specific treatment-related outcomes, (3) evaluate the association between NADC-specific diagnosis and new AIDS-defining illnesses and retention in HIV care, and (4) evaluate whether a diagnosis of both HIV and NADC, by cancer type, is associated with a higher risk of age-related outcomes as compared a diagnosis of HIV or NADC alone. Findings from this study will inform how aging in the presence of HIV affects the risk and consequences of non-AIDS defining cancers, and impacts HIV care and age-related outcomes among older adults. Importantly, we will evaluate our aims among a low-income, diverse population of men and women 50 years old with a comparison population with comparable risk factors and access to care.