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

摘要 非艾滋病定义癌症(NADCs)预计将占癌症患者所有癌症的89% 到2030年艾滋病毒(PLWH)，绝大多数被诊断为老年PLWH。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，PLWH在几个NADC中具有更高的癌症特异性死亡率， 在诊断出最常见的NADCs后，总体死亡率更高。死亡率较高的原因 NADC后的PLWH可能是多因素的，目前还不完全清楚。给出了大约 45%的人为50岁，84%的人在50岁到之间，了解这一交叉是至关重要的 HIV、NADDC和该人群的健康老龄化之间的关系。为有效的NADC的发展提供信息 预防和治疗策略对于PLWH人口老龄化，重要的是能够理清 HIV的影响来自与HIV感染相关的社会行为因素。为了做到这一点，一个对照小组 在风险因素负担相当的情况下，需要社会经济地位和获得护理的机会。大致 美国40%的PLWH由医疗补助覆盖。医疗补助受益人是一个多元化的群体，其中包括 有相似危险因素负担和获得护理的PLWH的对照组。医疗补助计划的人口是 对现有艾滋病毒资源的重要补充，包括(1)统计癌症发病率，但不包括 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 允许检查种族和性别差异的特定类型的癌症病例，如NA-ACCORD，以及(3) 其他以声称为基础的队列，捕捉到了艾滋病毒和普通人群中重要但不同的部分， 包括SEER-Medicare。我们建议评估500多万名医疗补助受益人的索赔50 在抗逆转录病毒治疗的现代时代，从2001年到2017年14个州的年龄：(1)量化 PLWH中按癌症类型划分的年龄、种族/民族和性别特定的NADCs发病率(2)评估 HIV感染与NADC特定治疗相关结果之间的关联，(3)评估这种关联 NADC特定诊断与新的艾滋病定义疾病和保留在艾滋病毒护理中之间的关系，以及(4)评估 根据癌症类型，同时诊断为HIV和NADC是否与年龄相关的更高风险相关 与单独诊断HIV或NADC的结果进行比较。这项研究的发现将告诉我们衰老是如何 艾滋病毒的存在影响非艾滋病定义癌症的风险和后果，并影响艾滋病毒护理 以及老年人中与年龄相关的结果。重要的是，我们将在低收入者中评估我们的目标， 50岁的男性和女性的不同人群与具有类似危险因素的比较人群 以及获得护理的机会。

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.