Chhatre Sumedha, Schapira Marilyn, Metzger David S, Jayadevappa Ravishankar
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
EClinicalMedicine. 2019 Nov 26;17:100205. doi: 10.1016/j.eclinm.2019.11.001. eCollection 2019 Dec.
To assess the interaction of breast cancer, HIV infection, Medicare disability status, cancer stage and its implications for outcomes, after accounting for competing risks among female, fee-for-service Medicare enrollees.
We used data from Surveillance, Epidemiology and End Results (SEER) -Medicare (2000-2013). From primary female breast cancer cases diagnosed between 2001 and 2011, we identified those with HIV infection. We used Generalized Linear Model for phase-specific incremental cost of HIV, Cox regression for association between HIV and all-cause mortality, and Fine and Gray competing risk models to assess hazard of breast cancer-specific mortality by HIV status. We also studied this association for subgroups of cancer stage and disability status.
Of 164,080 eligible cases of breast cancer, 176 had HIV infection. Compared to HIV-uninfected patients, HIV infected patients had 16% higher cost in initial phase, and 80% higher cost in interim stage of care, and at least two times higher mortality (all-cause and breast cancer-specific), after accounting for competing risk. Among disabled enrollees, HIV-infected patients had higher risk of all-cause and breast cancer-specific mortality, compared to HIV-uninfected patients.
Female fee-for-service Medicare enrollees with breast cancer experience higher initial and interim phase cost and worse survival in the presence of HIV. This association was also significant among disabled Medicare enrollees. Medicare is the single largest source of federal financing for HIV care. Burden on Medicare will grow exponentially due to higher proportion of disabled among HIV-infected enrollees, longer survival among HIV- infected persons, increased HIV incidence in older adults, and increased age related risk of breast cancer. Future research can identify the pathways via which HIV infection affects cost and mortality, and develop integrated strategies for effective management of concomitant breast cancer and HIV and inform survivorship guidelines.
National Institute on Aging, National Institutes of Health, Grant # R21AG34870-1A1.
在考虑女性按服务收费的医疗保险参保者中的竞争风险后，评估乳腺癌、艾滋病毒感染、医疗保险残疾状态、癌症分期之间的相互作用及其对结局的影响。
我们使用了监测、流行病学和最终结果（SEER）-医疗保险（2000 - 2013年）的数据。从2001年至2011年诊断出的原发性女性乳腺癌病例中，我们确定了那些感染艾滋病毒的病例。我们使用广义线性模型来计算艾滋病毒特定阶段的增量成本，使用Cox回归来评估艾滋病毒与全因死亡率之间的关联，并使用Fine和Gray竞争风险模型来评估按艾滋病毒状态划分的乳腺癌特异性死亡率的风险。我们还研究了癌症分期和残疾状态亚组中的这种关联。
在164,080例符合条件的乳腺癌病例中，有176例感染了艾滋病毒。与未感染艾滋病毒的患者相比，在考虑竞争风险后，感染艾滋病毒的患者在初始阶段成本高出16%，在护理中期阶段成本高出80%，全因死亡率和乳腺癌特异性死亡率至少高出两倍。在残疾参保者中，与未感染艾滋病毒的患者相比，感染艾滋病毒的患者全因死亡率和乳腺癌特异性死亡率风险更高。
患有乳腺癌的女性按服务收费的医疗保险参保者在感染艾滋病毒的情况下，初始和中期阶段成本更高，生存率更差。这种关联在残疾医疗保险参保者中也很显著。医疗保险是艾滋病毒护理的单一最大联邦资金来源。由于感染艾滋病毒的参保者中残疾比例更高、艾滋病毒感染者的生存期延长、老年人中艾滋病毒发病率增加以及与年龄相关的乳腺癌风险增加，医疗保险的负担将呈指数级增长。未来的研究可以确定艾滋病毒感染影响成本和死亡率的途径，并制定综合策略以有效管理乳腺癌和艾滋病毒的合并症，并为生存指南提供信息。
美国国立卫生研究院国家老龄化研究所，资助编号#R21AG34870 - 1A1。
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